Paediatric headache history

This post is designed to help you remember the sorts of questions you should be asking when taking a history of headache in a child.

Harry gets lots of headaches. In the morning, his headache wakes him up and he vomits all over the bed.

This makes his mother very angry and she smacks him over the head. He doesn’t notice the warning signs┬áthat she’s coming, because he has a very stiff neck.

He tries to get out of bed, but his legs have gone all tingly. So he crawls towards the bathroom, but he can’t really find it because his vision has gone all blurry, and the bright bedroom light hurts his eyes.

He goes downstairs to have his breakfast, but it hurts when he chews, and he starts coughing and spluttering because his nose is blocked.

Finally he says he wants to take the day off school because he has a fever his tummy hurts, but when he goes to lie down, the headache just gets worse!

Questions to ask:

  • What does it feel like?
    • Tight band – tension
    • Throbbing – migraine
    • smack in the head – subarachnoid haemorrhage
  • How bad is it 1-10?
    • worst ever – SAH
  • Where is it?
    • band around head – tension
    • unilateral – migraine
    • frontal/occipital – migraine
  • Do you have any ‘warning’ signs that it’s about to happen?
    • aura – migraine
  • Does it affect your vision at all?
    • migraine
  • Do you have any other sensory/movement changes?
    • migraine – children may get abdominal migraines and complain of tummy pain
    • raised ICP
  • Have you noticed if it occurs at a particular time of day?
    • pregnancy
  • Have you had them before?
  • Have you had a fever recently?
  • Have you noticed anything that sets it off?
    • Alcohol
    • Solvents
    • Drugs
    • Menses
    • Medications – are you on any medications?
  • Is it worse when you lie down?
    • Space occupying lesion – raised ICP
  • Have you been suffering from any neck stiffness?
    • meningitis
    • raised ICP
  • Have you had any photophobia?
    • meningitis
  • Have you had any morning vomiting?
    • SOL
    • viral illness
  • Has it woken you from sleep?
    • Migraine
  • Are there any stressors at school/home (emotional angst)
  • Have you had any problems with nasal congestion?
    • Sinusitis
  • Is it worse when you chew?
    • Temporomandibular Joint discomfort
  • Have you had your vision checked recently?
    • do they wear glasses?
    • Intracranial pressure – 6th nerve palsy
    • refractive error headache
  • Have you had any head trauma recently?
  • Have you had any changes in consciousness?
    • Raised ICP

Causes of acute headache in children:

  • Ice cream
  • Febrile illness
  • Migraine
  • Stress
  • Acute sinusitis
  • Meningitis/encephalitis
  • Subarachnoid/intracerebral haemorrhage
  • Medications
  • Benign intractranial hypertension
  • Reflex neuralgia

Types of headache:

  • Tension
  • Migraine
    • with aura
    • without aura
    • complicated
  • Space occupying lesion
  • Other
    • sinusitis
    • TMJ discomfort
    • Medication
    • Refractive error
    • Solvent/drug abuse
    • Benign intracranial hypertension
    • Hypertensive headache

can we stop now?

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