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Headaches are common in children, with the average age of onset at 7 for boys and 11 for girls. The frequency of migraine increases through adolescence. An estimated 8% to 23% of children aged 11 to 15 experience headaches. Headaches can be divided into two categories, primary or secondary. Primary refers to headaches that occur on their own and not as the result of some other health problem. Primary headaches (Figure 6-1) include migraine, migraine with aura, tension-type headache, and cluster headache.

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Secondary refers to headaches that result from some cause or condition, such as a head injury or concussion, blood vessel problems, medication side effects, infections in the head or elsewhere in the body, sinus disease, or tumors (Figure 6-2). Signs and symptoms of the underlying cause need to be searched for. Headaches associated with infection may represent a systemic reaction to the infection and do not necessarily signify severe disease. For example, strep throat is frequently associated with headaches. There are many different causes for secondary headaches, ranging from rare, serious diseases to easily treated conditions. Sometimes headaches occur almost every day and are called chronic daily headaches.

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Migraine is a headache condition that comes back again and again. Ten percent of children get migraines, and an even higher percentage of teenagers have them. These headaches are very painful and throbbing, and children who have them often look ill and pale. Relief is usually linked with sleep. One should focus on ruling out other serious diseases or conditions when first examining migraineurs.

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Migraineurs have various signs and symptoms. Typically, a child migraineur has a severe headache located around the eyes, in the front of the head, or in the temples. Some children experience vision changes ("auras") during a headache. A sick feeling in the stomach or vomiting is common. Many children avoid bright lights, loud noises, or strong odors, as these seem to make the headache worse. The severe head pain is often completely relieved by deep sleep. Recurring spells of dizziness may represent another form of migraine in children. An inherited tendency is believed to make some people more likely to have a migraine after some minor trigger (Table 6-1), although no single theory explains how the human body produces all the symptoms of a typical migraine headache. The key to recognizing migraines is identification of a pattern of short but very painful headache episodes that are relieved by sleep and separated by symptom-free intervals.

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Table 6–1. Migraine Triggers 

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