Pediatric Headache in the Emergency Department

Headache is defined as a somatic complaint. Incidence has increased in the last years probably due to childrens lifestyle changes. Headaches have a wide variety of causes, either primary or secondary ones. While the majority of headaches are self-limited and benign, headaches occasionally herald a life-threatening illness such as a brain tumor, intracranial hemorrhage or meningitis. The emergency department physician has to distinguish between "benign" and "serious" headaches and therefore must have an organized approach to the evaluation of these patients. Obtaining neuroimaging studies on a routine basis are not indicated in children with recurrent headaches. An extensive history and physical examination are crucial and must guide the differential diagnosis. Management in the ED must be addressed to establish an accurate diagnosis, ruling out secondary causes, by giving an effective treatment and by providing a discharge plan that includes treatment and follow up with their primary care physician.