Migraine headaches account for most primary childhood headaches. More than 90% of patients who present to a neurologist complaining of headache are estimated to have a migraine. Pediatric migraines are often bilateral, and clear localization of the pain can be difficult to obtain from children. Migraines in children are often of shorter duration than they are in adults.
Migraine without aura, or common migraine, is the more frequent form of migraine. Symptoms include headache pain that occurs without warning and is usually felt on one side of the head, along with nausea, confusion, blurred vision, mood changes, fatigue, and increased sensitivity to light, sound, or noise.
Migraine with aura
Migraine with aura, previously called classic migraine, is seen in 14-30% of children with migraine, and includes visual disturbances and other neurological symptoms that appear about 10 to 60 minutes before the actual headache and usually last no more than an hour.
Other types of headaches include migraine variants, abdominal migraine, hemiplegic migraine, basilar artery migraine, confusional migraine, and status migrainosus.
For migraine or tension headache in pediatric patients, a thorough history and physical examination usually suffice. Laboratory, radiologic, or electroencephalographic (EEG) studies are not useful to confirm the diagnosis of migraine but may be helpful in diagnosing an underlying seizure disorder with migraine-like presentation.
Diagnostic imaging is not routinely indicated unless a structural cause is suspected or the patient is very young and there is no family history. Modalities include Magnetic resonance imaging and on rare occasions Computerized Tomography (CT scan).
Management and treatment of headaches will be discussed once your child’s evaluation and any needed testing are completed.