Children and young people presenting with headaches are in our ‘Top 5’ most common outpatient presentations. It is important to try and distinguish between worrying pathology and less worrying symptoms. The ‘Headsmart’ website is very useful for this and lists the ‘red flag’ symptoms for each age group.
A neurological examination should be performed, including fundoscopy, appropriate to the child’s age and developmental stage.
A discussion with child and parents as to any personality changes, including concerns regarding new co ordination or balance problems is important. Teachers may have noticed a problem with handwriting or concentration in class.
In babies, an accurate occipito-frontal head circumference should be measured and plotted in the Red Book or other age-based centile chart.
For adolescents, a discussion about progress of puberty is important as arrested pubertal development is a ‘Red Flag’
In summary, children presenting with:
… should be discussed urgently with the on call Paediatrics via the PAU Telephone(accessed via switchboard) and will be seen either in the Paediatric Assessment Unit on the same day, or Rapid Access Clinic, as appropriate.
If there has been a recent, significant head injury (within the past 3 months), and the child has the symptoms above, please refer urgently for assessment.
Children presenting with fever and severe headache need urgent assessment and should be referred via the on call telephone.
Children and young people presenting with a sudden onset, severe occipital headache ‘thunderclap’ headache should be referred to urgent assessment via the on call telephone.
If there are no ‘red flags’, please also consider…
Recommended adequate daily fluid intake from drinks are:
There are many helpful resources to help deal with anxiety and stress, including…
These non-urgent cases can be referred to see a General Paediatrician in Children’s Outpatients via ERS. It helps if children and parents can come with a completed headache diary, so we can have an accurate feel of how frequent and troublesome the headaches are.
An example headache diary can be found here:
https://www.stgeorges.nhs.uk/wp-content/uploads/2014/11/SGH-Monthly-Headache-Diary.pdf
or from The Migraine Trust:
https://www.migrainetrust.org/wp-content/uploads/2015/11/FS05aMigraineDiaries.pdf
There are also some free apps available to allow you to record headaches – for example, Headapp.
Evidence of school attendance is also helpful so we can see how headaches are affecting schooling. An accurate percentage of school attendance, which parents can request from school, is helpful.
Children will be seen, have a neurological examination including fundoscopy and a discussion regarding treatment options. For some children, an onward referral may be appropriate to a tertiary headache clinic once assessed by General Paediatrics in secondary care.
The Migraine Trust has some helpful resources for those diagnosed with migraines
https://www.migrainetrust.org/
