Riassunto

Headaches are common in children, increasing in incidence from early childhood to adolescence. They account for 0.7% to 1.3% of all paediatric emergency department visits. [1] [2] Headaches may be classified as primary or secondary. [3] Primary headaches include migraine, tension-type, and cluster headaches. Secondary headaches are symptomatic of an underlying intracranial or medical condition that requires treatment. The initial assessment of acute headache aims to determine whether there is a secondary cause for headache that requires urgent intervention.

Clinical classification

Headache may be classified in terms of time course.

Acute headache

• A single episode of headache pain without prior headaches.

• May represent the first or an unusually severe form of primary headache.

• May suggest a new acute secondary cause for headache that, therefore, requires evaluation.

Acute recurrent headache

• Stereotyped headaches separated by headache-free periods.

• Most suggestive of a primary headache disorder, especially if the pattern has persisted for a long period.

• May also occur in secondary headache, as with intermittent elevation in intracranial pressure.

Chronic progressive headache

• A gradual increase in headache.

• Suggestive of an expanding intracranial lesion.

• Of children with brain tumours, 62% have headache prior to diagnosis, and 98% have at least one neurological symptom or abnormality on examination. [4]

• The most common symptoms include nausea or vomiting, difficulty walking, visual symptoms, focal weakness, or personality change. [4]

• The most common signs include papilloedema, abnormal eye movements, ataxia, abnormal reflexes, and visual field or acuity defects. [4]

Chronic non-progressive headache

• Constant steady headache.

• May be due to a chronic type of primary headache or similar secondary aetiologies.

Migraine diagnostic criteria

Diagnosis of migraine without aura requires: [3] [5]

• A: At least 5 attacks fulfilling criteria B-D

• B: Headache attacks lasting 1 to 72 hours

• C: Headache having at least 2 of the following characteristics:

  • Unilateral location, may be bilateral, frontotemporal (not occipital)

  • Pulsing quality

  • Moderate or severe pain intensity

  • Aggravation by or causing avoidance of routine physical activity (e.g., walking, climbing stairs)

• D: During the headache, at least one of the following:

  • Nausea or vomiting

  • Photophobia and phonophobia, which may be inferred from behaviour

• E: Not attributable to another disorder.

Diagnosis of migraine with aura requires:

• A: At least 2 attacks fulfilling the criteria B-D

• B: Aura consisting of at least 1 of the following, but no motor weakness:

  • Fully reversible visual symptoms (flickering lights, spots, or lines)

  • Fully reversible sensory symptoms, including positive features (pins and needles) or negative features (numbness)

  • Fully reversible dysphasic speech disturbances

• C: At least 2 of the following:

  • Homonymous visual symptoms or unilateral sensory symptoms

  • At least 1 aura symptom developing gradually over >5 minutes or different aura symptoms occurring in succession over >5 minutes

  • Each symptom lasting >5 minutes and <60 minutes

• D: Not attributable to another disorder.