Version May 2024
| 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 |
| Absence of aura |
| Chronic progressive headache pattern |
| Change in quality, severity, frequency, or pattern of headache |
| Occipital headache |
| Recurrent localized headache |
| Lack of response to medical therapy |
| Headache duration of less than six months |
| Patient history |
| Inadequate history (description of headache and relative features) |
| 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, pre-existing hydrocephalus or shunt) |
| Age <6 years |
| Personality change |
| Deterioration of school work |
| Associated symptoms in the neck or back |
| Family history |
| Absence of family history of migraine |
| Examination findings |
| Child uncooperative (unable to complete neurologic examination) |
| 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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