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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 costs.


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 Society.4,5


The criteria for migraine with and without aura are shown in Table 565-1.

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Table 565-1. Criteria for Migraine with and Without Aura

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