eMedicine Specialties > Neurology > Pediatric Neurology

Migraine Headache, Pediatric Perspective: Differential Diagnoses & Workup

Author: William C Robertson Jr, MD, Professor, Departments of Neurology, Pediatrics, and Family Practice, Clinical Title Series, University of Kentucky College of Medicine
Contributor Information and Disclosures

Updated: Nov 30, 2009

Differential Diagnoses

Childhood Migraine Variants
Migraine Headache
Chronic Paroxysmal Hemicrania
Migraine Headache: Neuro-Ophthalmic Perspective
Cluster Headache
Migraine Variants
Head Injury
Muscle Contraction Tension Headache
Headache: Pediatric Perspective
Intracranial Hemorrhage

Other Problems to Be Considered

Analgesic rebound headache
Benign exertional headache
Caffeine headache
Chronic daily headache
Inflammatory sinus disease
Posttraumatic headache
Tension headache

Workup

Laboratory Studies

Only the small percentage of headache patients in whom a nonmigrainous cause is suspected requires further laboratory and radiologic studies.

Imaging Studies

  • A neuroimaging study typically is not necessary in adults with a chronic (>6 mo) history of headaches, normal neurologic examination findings, and no seizures. Although similar data on children are not available, headache alone is not a sufficient reason to order a neuroimaging study.
  • Studies have shown that children with a history consistent with migraine and normal neurologic examination findings will not have abnormalities on head CT scans or cranial MRIs. A small percentage of migrainous children may have incidental and unrelated findings, but routine neuroimaging is not necessary in juvenile migraine patients. However, children with chronic progressive headaches or those younger than 4 years probably should have a cranial MRI.
  • Consider an imaging study in patients with a history of seizures, recent head trauma, significant change in the headache, or evidence of focal neurologic deficits or papilledema upon physical examination. No absolute rules exist in the evaluation of the headache patient; the need for a neuroimaging study ultimately is based on clinical judgment.
  • Electroencephalography is not useful in the routine evaluation of headache patients. Reserve it for patients with an atypical migraine aura, episodic loss of consciousness, or symptoms suggestive of a seizure disorder. Focal or diffuse background slowing can be seen during a migraine headache, particularly hemiplegic or confusional migraine; however, electroencephalography results are often normal.

Procedures

  • Lumbar puncture is indicated if meningitis, encephalitis, subarachnoid hemorrhage, or high-low pressure syndromes are considered. Cerebrospinal fluid examination and pressure measurements are not indicated unless the history or examination findings are not consistent with juvenile migraine.
  • Patients in whom elevated intracranial pressure is suggested or those with focal neurologic deficits should undergo a neuroimaging study prior to a lumbar puncture.

More on Migraine Headache, Pediatric Perspective

Overview: Migraine Headache, Pediatric Perspective
Differential Diagnoses & Workup: Migraine Headache, Pediatric Perspective
Treatment & Medication: Migraine Headache, Pediatric Perspective
Follow-up: Migraine Headache, Pediatric Perspective
References
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Further Reading

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Keywords

migraine in kids, migraine headache in children, abdominal migraine, acute confusional migraine, basilar migraine, benign paroxysmal vertigo of childhood, Bickerstaff syndrome, classic migraine, common migraine, complex migraine, complicated migraine, cyclic vomiting syndrome, familial hemiplegic migraine, migraine equivalent, migraine sine hemicrania, migraine with aura, migraine without aura, paroxysmal torticollis of infancy, status migrainosus, ophthalmic (retinal) migraine, ophthalmoplegic migraine, migraine variant

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Contributor Information and Disclosures

Author

William C Robertson Jr, MD, Professor, Departments of Neurology, Pediatrics, and Family Practice, Clinical Title Series, University of Kentucky College of Medicine
William C Robertson Jr, MD is a member of the following medical societies: American Academy of Neurology and Child Neurology Society
Disclosure: Nothing to disclose.

Medical Editor

Raj D Sheth, MD, Professor of Neurology, Mayo College of Medicine; Chief, Division of Pediatric Neurology, Nemours Children's Clinic
Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, and Child Neurology Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James H Halsey, MD, Professor, Department of Neurology, University of Alabama Medical Center
James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Neurology, Department of Neurology, Oregon Health and Science University; Consulting Staff, Shriners Hospital for Children
Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

 
 
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