Headaches in children: a clinical lecture

Abstract

Headaches are perhaps the most common complaint in children. Unfortunately, often not enough attention is paid to this complaint. Often, primary headache (tension headache, migraine) is interpreted as a symptom of a neurological or other disease, less often the opposite. Not enough attention is paid to the collection of an anamnesis, which determines the correct diagnosis for 90%. Despite its high prevalence, most of our knowledge about pathophysiology, diagnostic criteria and treatment methods is based on extrapolation of the results of studies conducted on adult patients. These extrapolations should be carried out carefully in the pediatric age group, since there are significant differences between children and adults in relation to the development and maturation of neuronal networks, psychosocial development and status, and therefore the pathophysiology and prevalence of various types of headaches. These differences, with respect to the type and manifestations of headaches in children and adolescents, can shed light on the progression of childhood headaches in adulthood. We present a description of the clinical picture, diagnostic criteria, and treatment features for the most typical forms of headaches in children: tension headaches, migraines, infectious diseases (including meningococcal meningitis), diseases of ENT organs, urgent conditions, such as traumatic brain injury and subarachnoid hemorrhage. Also, attention is paid to some genetic syndromes CADASIL and MELAS. Special attention is paid to the so-called red flags dangerous symptoms that require immediate diagnostic or treatment procedures. The lecture presents the practical features of the clinical and neurological examination of children with headache complaints, modern classifications of tension and migraine headaches, age-specific prescribing algorithms, illustrations including the results of MRI, external examination of patients, and the course of various forms of headache.