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Acute Headache in Children and Adolescents Presenting
to the Emergency Department
Lewis DW, Qureshi, Headache 2000
Posted June 2001
Headache 2000

Objectives: Our goals were (1) to investigate the causes of acute headache in children from the emergency department perspective and (2) to search for clinical clues that might distinguish headache associated with serious underlying disease.

Background: The clinical presentation of headache in children and adolescents can be separated into 5 temporal patterns: acute, acute-recurrent, chronic progressive, chronic nonprogressive, and mixed. Few data exist regarding acute headache in children.

Methods: Consecutive children who presented to our emergency department with the abrupt onset of severe headache were prospectively evaluated. The headache character, location, severity, and associated symptoms, as well as underlying causes, were recorded using a standardized survey.

Conclusion: In children and adolescents, the abrupt onset of severe headache is most frequently caused by upper respiratory tract infection with fever, sinusitis, or migraine. Special attention is warranted if the acute headache is occipital in location and if the affected patient is unable to describe the quality of the pain. Serious underlying processes such as brain tumor or intracranial hemorrhage are uncommon and, when present, are accompanied by multiple neurological signs (ataxia, hemiparesis, papilledema).