Chronic headache in children may be a manifestation of either a benign or serious underlying condition. A thorough history and complete neurological examination is required to distinguish between these. In particular, complaints of headache in a young child should raise concerns for a more sinister etiology.
In the anxious child, history is often non-specific, however identification of stress provoking factors and key social determinants are essential. There may or may not be a history of mental health issues in the family. The neurological examination must always be normal.
Red flags for sinister causes of headache include:
• young age
• fever
• occipital headache
• morning vomiting
• night-time awakenings
• any abnormalities on neurological exam
