Characteristics of common headache syndromes in children and adolescents

Symptom	Migraine	Tension-type headache	Trigeminal autonomic cephalalgia (eg, cluster headache)
Location	Commonly bilateral in young children; in adolescents and young adults, unilateral in 60 to 70% and bifrontal or global in 30%	Bilateral	Always unilateral, usually begins around the eye or temple
Characteristics	Gradual in onset, crescendo pattern; pulsating; moderate or severe intensity; aggravated by routine physical activity	Pressure or tightness that waxes and wanes	Pain begins quickly, reaches a crescendo within minutes; pain is deep, continuous, excruciating, and explosive in quality
Patient appearance	Patient prefers to rest in a dark, quiet room	Patient may remain active or may need to rest	Patient remains active
Duration	2 to 72 hours	Variable	30 minutes to 3 hours
Associated symptoms	Nausea, vomiting, photophobia, phonophobia; may have aura (usually visual, but can involve other senses or cause speech or motor deficits)	None	Ipsilateral lacrimation and redness of the eye; stuffy nose; rhinorrhea; pallor; sweating; Horner syndrome; focal neurologic symptoms rare; sensitivity to alcohol

* May be inferred from the behavior of young children.

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