[Childhood headache. A diagnostic approach]

Headaches are common during childhood and become more frequent in adolescence. The rational, cost-effective evaluation of children with headache begins with a careful history. The first step is to identify the temporal pattern of the headache -acute, acute-recurrent, chronic-progressive, chronic-nonprogressive, or mixed. The next step is a physical and neurologic examination. Neuroimaging is not routinely warranted in the evaluation of childhood headache and should be reserved for use in children with acute or chronic-progressive patters of abnormalities in neurologic examination. Pediatric migraine differs from adult migraine. Recent studies indicate the need to revise diagnostic criteria for pediatric migraine, which would allow its real prevalence in this age group to be determined. The sensitivity and specificity of the International Headache Society (IHS) criteria for childhood migraine would be increased if the minimum duration of migraine were reduced and if a diagnosis of migraine were allowed when severe headache is associated with nausea, even though the criteria of location, quality, and aggravation by physical activity are not fulfilled. There are no differences in the fulfillment of the IHS criteria for migraine and tension-type headache between children and adolescents. Independent of age, the intensity of headache and the presence or absence of nausea are the most important features for differentiating the two major types of idiopathic headache.Migraines, migraine variants, tension headache and other types of headache often present for the first time during childhood and require close follow-up by the pediatrician. Investigation into this disorder is still developing.