Related Experiment Video

Updated: Jun 17, 2026

A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
07:01

A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)

Published on: February 7, 2025

Beyond ICHD-3 criteria: Diagnostic challenges in headache in pediatric age

Laura Papetti1, Alessandro Borrelli1, Carmen Granata2

  • 1Developmental Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

Cephalalgia : an International Journal of Headache
|June 16, 2026
PubMed

Insights

Diagnosing pediatric headaches is complex due to age variations and overlapping symptoms. Accurate diagnosis requires careful history, age-specific pattern recognition, and judicious use of tests, with pediatric-focused guidelines needed.

Area of Science:

  • Pediatric Neurology
  • Diagnostic Medicine
  • Evidence-Based Practice

Background:

  • Headache diagnosis in children and adolescents presents unique challenges.
  • Clinical features vary significantly with age, complicating differentiation between primary and secondary headaches.
  • Inconsistent application of diagnostic investigations further increases diagnostic uncertainty.

Purpose of the Study:

  • To review and synthesize current evidence on diagnosing headaches in pediatric populations.
  • To identify challenges and pitfalls in current diagnostic approaches for pediatric headaches.
  • To explore potential improvements and future directions for pediatric headache diagnosis.

Main Methods:

  • A comprehensive scoping review was conducted following PRISMA guidelines.
  • Searches were performed across major databases (PubMed, MEDLINE, Scopus, Cochrane Library) for studies published between 2018 and 2025.
  • 36 eligible studies were included from an initial 126 records identified.

Main Results:

  • International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria, primarily designed for adults, may not adequately capture pediatric presentations.
  • The diagnostic utility of certain 'red flag' symptoms is clarified, while others are questioned.
  • Neuroimaging has limited diagnostic yield in most cases, and common pitfalls include overdiagnosis of sinusitis and inappropriate use of EEG and other specialist tests.

Conclusions:

  • Accurate pediatric headache diagnosis hinges on detailed history taking and recognizing age-specific patterns.
  • Judicious selection and use of diagnostic investigations are crucial.
  • Development of pediatric-specific diagnostic pathways and integration of emerging digital tools and biomarkers are recommended for improved diagnostic accuracy.

Keywords:
adolescentschildrendiagnosisheadachered flagssecondary headache

More Related Videos

Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure15:18

Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure

Published on: July 30, 2009

Related Concept Videos

Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Attention-Deficit/Hyperactivity Disorder01:30

Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent inattention, hyperactivity, and impulsivity. It affects approximately 5-8% of children globally, with around 60-70% of cases persisting into adulthood. ADHD has significant implications for educational attainment, social interactions, and occupational success.
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
Bacterial Meningitis I: Introduction01:22

Bacterial Meningitis I: Introduction

Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
Encephalitis l: Introduction01:19

Encephalitis l: Introduction

Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...