1. Common Headaches in Children: What NPs Should Know
Sharon B. Stevenson DNP, APRN, PPCNP-BC
University of Arkansas for Medical Sciences College of Nursing
Arkansas Children’s Neurology
PURPOSE
GUIDELINES
To assist Nurse Practitioners identify common headache types, including characteristics of common headache syndromes and those “can’t afford to miss” warning symptoms in children and adolescents.
BACKGROUND AND SIGNIFICANCE
Headache is the most common neurologic disorder in children, affecting as many as 88% of the pediatric and adolescent population. The vast majority of children and adolescents with a normal neurological examination do not have serious underlying causes for headaches, such as central nervous system tumors or chronic systemic conditions. Often times the initial visit and subsequent visits are with the nurse practitioner (NP). Getting the correct headache diagnosis is the first step in preventing delays in appropriate care and management, improve quality of life and reduce unnecessary testing for children with headaches.
Both the National Institute for Health and Care Excellence (NICE) and the International Headache Society (IHS) have published clinical guidelines for headache assessment and diagnosis. In 2013, the IHS published the International Classification of Headache Disorders, 3rd edition providing detailed diagnostic criteria for primary headaches, secondary headaches, and facial pain disorders provided updates to practice guidelines for adults and children. Similarly, in 2013 NICE updated clinical guidelines for assessment, diagnosis, and management of headaches in 12 years old and older. Though the most common primary headaches in children are migraine and tension-type headache, guidelines have been developed to be aware of when children present with “red flag” or worrisome headache symptoms.
Abnormal neurological examination
Atypical presentation of the headache; vertigo, intractable vomiting, and nocturnal awakening headache
Recent headache of < 6 months
Child of < 6 years old
No family history of migraine and/or primary headache
Occipital headache
Change in headache type
Subacute progressive headache severity
New-onset headache in immunosuppressed child
First and/or worst headache
Systemic symptoms and signs
Headache associated with confusion, altered mental status or focal neurological complaints
NICE, 2013 .
American Headache Society, 2013
Clinical Implications
Evaluation of headaches in children includes a comprehensive history, physical and neurological examination. The primary care provider, particularly NPs have an important role as the first encounter for children who present with headaches. NPs knowledgeable about the diagnostic criteria for common headache disorders in children can help prevent delays in diagnosis and lead to positive patient outcomes.
References
Bonthius, D.J., Andrew G Lee, A.G., and Hershey, A.D. (2017). Headache in children: Approach to evaluation and general management strategies. Up to Date. Retrieved from
Langdon, R. and DiSabella, M.T. (2017). Pediatric headache: An overview. Current Problems in Pediatric and Adolescent Health Care, 47,
Levin, M. (2013). The International Headache Classification of Headache Disorders, 3rd Edition (ICHD III) – Changes and Challenges. Headache Currents- Clinical Review, 53(8), doi: /head.12189
Loder, E., Weizenbaum, E., Frishberg, B., Silberstein, S. and American Headache Society Choosing Wisely Task Force (2013), Choosing Wisely in Headache Medicine: The American Headache Society’s List of Five Things Physicians and Patients Should Question. Headache: The Journal of Head and Face Pain, 53: 1651–1659. doi: /head.12233
National Institute for Health and Care Excellence (2013). Headaches in over 12s. Quality
standard. Retrieved from