Evaluation of secondary headache in children

This figure summarizes our suggested approach to the evaluation of secondary headache in children. Findings suggestive of secondary headache include fever, altered mental status, nuchal rigidity, posttraumatic, sudden onset, severe pain, papilledema, abnormal neurologic examination, and age <6 years. Imaging and lumbar punctures should be conducted urgently. For additional details, refer to UpToDate content on the diagnosis of headache.

CN: cranial nerve; CT: computed tomography; ICP: intracranial pressure; IIH: idiopathic intracranial hypertension; LP: lumbar puncture; MRI: magnetic resonance imaging.

* For additional features that may indicate intracranial pathology, refer to UpToDate content on headache.

¶ If signs of a space-occupying lesion are progressing rapidly, then obtain CT with contrast instead of MRI.

Δ Examples of meningitis symptoms include fever, headache, nuchal rigidity, and photophobia. Examples of viral encephalitis symptoms include fever, change in mental status, coma, and seizures. Refer to UTD topics on headache, meningitis, and viral encephalitis for additional examples.

◊ Examples of orbital extension of sinusitis include eyelid swelling and/or erythema, periorbital swelling and/or erythema, and pain with and/or limitation of eye movement. Examples of intracranial extension of sinusitis include, ptosis, proptosis, limitation of eye movement, and bilateral periorbital edema. Refer to UpToDate topics on headache and sinusitis for additional examples.

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Evaluation of secondary headache in children