Primary headaches, including migraine headaches and tension-type
headaches, are common during childhood, often occur together in
an individual, and are most frequently reported during adolescence.
The reported prevalence for migraine headache is estimated at 3% for
ages 3 to 7 years (males > females), 4% to 11% for
7 to 11 years (males = females), and 8% to 23% for 11
to greater than 15 years (females > males).1 Children less
than 3 years of age may have a forme fruste of migraine which presents
as periodic irritability, head-banging or holding, change in sleep
and behavioral patterns, abdominal pain, recurrent vomiting, and
pallor. Reports of nonspecific headache pain are even more common.
By age 5 years, 20% of children report experiencing a headache,
40% by age 7 years, and 100% by age 16 years.2 Most
of these episodes are benign. However, recurrent headaches may present
with severe pain, decreased academic performance and school absence,
anxiety, depressed mood, family disruption, and high health care
The criteria for the diagnosis of migraine vary, but most children
have 2 or more of the following features: unilateral; throbbing
quality; associated aura; abdominal pain, nausea, or vomiting; relief
after sleep; and a positive family history. Unique features in children
include shorter duration with sleep included as part of the duration,
the increased incidence of bilateral location, especially frontal
and bitemporal, and ability to include parental observation of photo- and
phonophobia. Migraine without aura is most prevalent. For migraine
with aura, visual symptoms are the most typical auras. An aura generally
develops over > 5 minutes, may precede or accompany the head pain,
or may occur without headache. It lasts no more than 60 minutes.
Visual aura may be reported as brightly colored or moving lights,
distorted images of the environment, scotomata, visual field defects,
or fortification spectra.1 Tension-type headache is classified
based on adult criteria.3
The formal diagnosis of primary headache in children is based
on clinical criteria modified in 2004 by the International Headache
The criteria for migraine with and without aura are shown in Table 565-1.
565-1. Criteria for Migraine with and Without Aura |Favorite Table|Download (.pdf)
565-1. Criteria for Migraine with and Without Aura
|1. More than or equal to 5 attacks fulfilling 2 through 4|
|2. Headache attack lasting 1 to 72 hours|
|3. Headache has at least 2 of the following 4 features:|
|a. Either the bilateral or unilateral (front/temporal)
|b. Pulsating quality|
|c. Moderate to severe intensity|
|d. Aggravated by routine physical activities|
|4. At least 1 of the following accompanies headache:|
|a. Nausea or vomiting|
|b. Photophobia and phonophobia (may be inferred
|5. At least one of the following:|
|a. History and physical and neurological examinations
do not suggest an organic disorder, including head trauma; vascular
disorders; nonvascular intracranial disorder; substances or their ...|
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