Pediatric Headache in Emergency Medicine 

  • Author: Kirsten A Bechtel, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Mar 26, 2010
 

Background

Headache is a common reason for children to seek medical care. Headaches in children may be due to numerous causes, such as migraine and its variants, intracranial masses, or sinusitis. This article discusses the important and common causes of headache in the pediatric population.

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Pathophysiology

Because the brain is insensate, headache is due to the stimulation of pain sensitive nerve fibers in large cerebral arteries and veins, the periosteum of the skull, the muscle and skin of the scalp, the sinus mucosa, the temporomandibular joint, the teeth, or the gingiva.

The pathophysiology of migraine headache is multifactorial. The onset of a migraine headache is thought to be mediated by cortical spreading depression (CSD), which is due to neuronal activation followed by suppression, which spreads over the cortical surface. A simultaneous change occurs in cerebral blood flow, characterized by hyperperfusion, followed by hypoperfusion. CSD is thought to be caused by either trauma or changes in the local concentrations of hydrogen ions, potassium, and glutamate. CSD activates CNS nociceptors, possibly through the release of nitric oxide, atrionatriuretic factor, activation of noradrenergic pathways, and/or changes in cerebral blood flow. CSD also causes neurogenic inflammation, which also stimulates the release of several different neurotransmitters that lead to cerebral vasodilatation and activation of CNS nociceptors.

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Epidemiology

Frequency

United States

Nearly 40% of all Americans have a significant headache at some time. Children frequently complain of headache. Headaches are very common during childhood and become increasingly more frequent during adolescence.

The prevalence of headache, in general, ranges from 37-51% during the elementary school years and gradually rises to 57-82% by the high school years. Frequent or severe headaches, including migraines, were reported over a 12-month period in 17% of a national sample of children and adolescents.[1] The most frequent type of recurrent headache in childhood is migraine; in adolescents, tension headaches are the most common cause of frequent headache.[2] Before puberty, reports indicate that boys are more frequently affected than girls, but, following the onset of puberty, headaches are reportedly more frequent in girls.

Mortality/Morbidity

Headache can cause significant disruption in a child's daily activities. For example, children with migraine headache are often not appropriately diagnosed and thus go untreated. In a large study looking at the prevalence of migraine headache, 31% of patients reported that they had missed at least one day of school or work in the previous 3 months. In this same study, more than half of patients reported that their productivity was reduced by 50%. Some authors believe that children and adolescents with recurrent migraines experience a reduction in their quality of life similar to that of children with cancer.[3]

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Contributor Information and Disclosures
Author

Kirsten A Bechtel, MD  Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

William G Gossman, MD  Associate Clinical Professor of Emergency Medicine, Creighton University School of Medicine; Consulting Staff, Department of Emergency Medicine, Creighton University Medical Center

William G Gossman, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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