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Headaches are a fairly frequent complaint in children, and most
are not a serious problem. However, they may be an early symptom
of serious disorders such as an intracranial tumor or idiopathic
intracranial hypertension. A careful history and examination are
necessary to determine whether additional testing or referral to
a pediatric ophthalmologist or neurologist is indicated. If the
history is consistent with migraine or tension headache and the
examination is otherwise normal, symptomatic treatment may be all
that is necessary. If the history or examination suggests the possibility
of increased intracranial pressure, then imaging studies and referral
to a pediatric neurologist are indicated.
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The eyes themselves are rarely the cause of headache, but an
ophthalmological examination may be necessary to rule out this possibility.
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What Shouldn’t
Be Missed
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Migraine headaches are not uncommon in children. They may present
with an initial complaint of abnormal visual phenomenon (prodrome).
Recognition of migraines is important both for treatment and to
avoid unnecessary testing. Less commonly, headaches may result from
intracranial tumors or other serious disorders. The presence of
papilledema indicates the need for prompt evaluation.
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- 1. Migraine headache. Migraine
headaches are more common in children than is often recognized.
These may present with specific complaints of eye pain, which may
be retro- or periorbital. Classic migraines are accompanied by prodromal
syndromes, which are often visual, such as sparkling lights, jagged lines,
or visual field defects (Figure 22–1). Most patients develop
headaches in association with these phenomena, but the abnormal
visual sensations sometimes occur without the headache (acephalgic migraine). The features
of the headache, normal eye examination after the symptoms resolve,
and the presence of a family history of migraines help in establishing
a diagnosis.
- 2. Tension headache. Tension
headaches also occur in children, but are less severe. Patients
typically do not specifically complain of eye pain. The headaches
tend to occur in specific situations, such as while at school.
- 3. Eyestrain....