Headaches in Children and Adolescents -- American Family Physician

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 625 assessment (Table 1) should generate sufficient information to make a diagnosis. The questions contained in this assessment can guide the physician in assigning a patient’s symptom complex to the appropriate temporal pattern (Table 2) and help identify patients who warrant further diagnostic testing. The general physical examination must include determination of vital signs, including blood pressure and temperature. Careful palpation of the head and neck should be performed in a search for sinus tenderness, thyromegaly, or nuchal rigidity. Head circumference must be measured, even in older children, because slowly progressive increases in intracranial pressure cause macrocrania. The skin must be examined for signs of neurocutaneous syndrome, particularly neurofibromatosis and tuberous sclerosis, which are highly associated with intracranial neoplasms. A detailed neurologic examination is essential. More than 98 percent of children with brain tumors have objective neurologic findings. Key features in children with intracranial disease include altered mental status, abnormal eye movements, optic disc distortion, motor or sensory asymmetry, coordination disturbances, and abnormal deep tendon reflexes. Careful physical and neurologic examinations can enable the physician to exclude organic causes. H eadaches are common during childhood and become more common and more frequent during adolescence. An epidemiologic survey of 9,000 school children found that one third of the children who were at least seven years of age and one half of those who were at least 15 years of age had headaches. “Frequent” headache was reported in 2.5 percent of children who were at least seven years of age and 15 percent of those who were at least 15 years of age. The prevalence of headache ranged from 37 to 51 percent in those who were at least seven years of age and gradually rose to 57 to 82 percent by age 15. Before puberty, boys are affected more frequently than girls, but after the onset of puberty, headaches occur more frequently in girls.