Acute headache in children and adolescents presenting to the emergency department

Objectives.-Our goals were (1) to investigate the causes of acute headache in childhood from the emergency department perspective and (2) to search fo r clinical clues that might distinguish headache associated with serious un derlying disease. Background.-The clinical presentation of headache in children and adolescen ts can be separated into 5 temporal patterns: acute, acute-recurrent, chron ic progressive, chronic nonprogressive, and mixed. Few data exist regarding acute headache in children. Methods.-Consecutive children who presented to our emergency department wit h the abrupt onset of severe headache were prospectively evaluated. The hea dache character, location, severity, and associated symptoms, as well as un derlying causes, were recorded using a standardized survey. Results.-One hundred fifty children, aged from 2 to 18 years, 87 boys and 6 3 girls, were enrolled over a 10-month period. Upper respiratory tract infe ction with fever (viral upper respiratory tract infection 39%, sinusitis 9% , streptococcal pharyngitis 9%) was the most frequently identified cause of acute headache (57%). Other causes included migraine (18%), viral meningit is (9%), posterior fossa tumors (2.6%), ventriculoperitoneal shunt malfunct ion (2%), epileptic seizure (postictal headache) (1.3%), concussion (postco ncussive headache) (1.3%), intracranial hemorrhage (1.3%), and undetermined (7%). Two clinical features were found to have statistically significant a ssociations with serious underlying disease: occipital location of headache anti an inability of the patient to describe the quality of the head pain. All children with surgically remediable conditions had clear and objective neurological signs. Conclusions.-In children and adolescents, the abrupt onset of severe headac he is most frequently caused by upper respiratory tract infection with feve r, sinusitis, or migraine. Special attention is warranted if the acute head ache is occipital in location and if the affected patient is unable to desc ribe the quality of the pain. Serious underlying processes such as brain tu mor or intracranial hemorrhage are uncommon and, when present, are accompan ied by multiple neurological signs (ataxia, hemiparesis, papilledema).