• Headache
is a common complaint in children and teenagers.Headaches can be a primary
problem themselves or represent a symptom of another disorder and therefore
represent a secondary headache.Recognizing this difference is essential
for choosing the appropriate evaluation and treatment to ensure successful
management of the headache.
• Primary headaches are most often recurrent, episodic headaches and for most children are
sporadic in their presentation.The most common forms of primary headaches of
childhood are migraine and tension-type headaches.The primary
headaches can progress to very frequent headaches with chronic migraine and
chronic tension-type headaches being increasingly recognized. These more
frequent headaches can have an enormous impact on the life of the child and
adolescent, as reflected in school absences and decreased school performance,
social withdrawal, and changes in family interactions.To reduce this impact, a
treatment strategy that incorporates acute treatments, preventive treatments,
and biobehavioral therapies must be implemented.
• Secondary headaches are headaches that are a symptom of an underlying illness.The underlying
illness should be clearly present as a direct cause of the headaches.This is
often difficult when 2 or more common conditions occur in close temporal
association. This frequently leads to the misdiagnosis of a primary headache as
a secondary headache. This is frequently the case when migraine is misdiagnosed
as a sinus headache.In general, the key components of a secondary headache are
the likely direct cause and effect relationship between the headache and the
precipitating condition.In addition, once the underlying suspected cause is
treated, the secondary headache should resolve.If this does not occur, either
the diagnosis must be re-evaluated or the effectiveness of the treatment
reassessed. One key clue that additional investigation is warranted is the
presence of an abnormal neurologic examination or unusual neurologic symptoms.
•
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