Clinical: Clinical Review - Headache in children.(Clinical report)

Section 1: Aetiology and epidemiology Headache is the most frequent neurological symptom, and a common manifestation of pain in children.1

Patients want answers to three questions: what is the cause of their headache, what would make it better, and reassurance they do not have a life-threatening illness.

Unfortunately, the management of headache in children is often poor. The barriers to successful treatment are more prominent than in adults, because diagnosis is often more difficult and the patient less likely to articulate their problems and seek help.

Extent of the problem

Between 20-30 per cent of children report headaches at least weekly, and 6 per cent have headaches several times a week or daily. Migraine is the most common type of headache with a peak incidence at the age of 15 years in girls and 10 years of age in boys.

A large UK school clinical study reported an annual prevalence rate of 10.6 per cent for migraine and 0.9 per cent for tension type headache.2

Headache has an impact on a child's life in a number of ways, including school absences and decreased socialisation with peers. In a survey of 2,500 children in our practice, we found that 3 per cent of children had a significant problem with headache affecting them on one day in four, with an average of 14 days of school lost each year.3

Headache during childhood also has a high risk of persisting into adulthood with associated physical and psychiatric morbidity later in life. For example, over a third of children with migraine will experience the problem in adulthood.4,5

Children suffering from headache are more sensitive to other types of pain in general. However, the nature of a recognised link between migraine and other periodic syndromes is not …