| Headache characteristics |
- Headache awakens the child or occurs consistently upon awakening from sleep
- Short or paroxysmal headache; thunderclap headache (uncommon in children)
- Associated neurologic signs and symptoms (eg, persistent nausea/vomiting, altered mental status, ataxia, etc)
- Headache worsened in recumbent position or by cough, micturition, defecation, or physical activity
- Chronic progressive headache pattern
- Change in quality, severity, frequency, or pattern of headache
- Exclusively occipital headache
- Lack of response to medical therapy
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| Patient history |
- Inability of child to describe headache (eg, young age, limited intellectual ability or communication skills)
- Risk factor for intracranial pathology (eg, sickle cell disease, immune deficiency, malignancy or history of malignancy, coagulopathy, cardiac disease with right-to-left intracardiac shunt, head trauma, neurofibromatosis type 1, tuberous sclerosis complex, preexisting hydrocephalus or shunt)
- Age ≤6 years
- Personality change
- Deterioration in school performance
- Associated symptoms in the neck or back
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| Examination findings |
- Abnormal neurologic examination (eg, ataxia, weakness, diplopia, abnormal eye movements, other focal signs)
- Papilledema or retinal hemorrhages
- Growth abnormalities (increased head circumference, short stature or deceleration of linear growth, abnormal pubertal progression, obesity)
- Nuchal rigidity
- Signs of trauma
- Cranial bruits
- Skin lesions that suggest a neurocutaneous syndrome (neurofibromatosis, tuberosis sclerosis complex)
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