Headaches are common in children and adolescents, the most common pain complaint when seeking medical advice. Primary headaches are one of the most common disorders of childhood, with migraine and tension type headache (TTH) being the most frequent ones. In spite of their prevalence, there is paucity of knowledge regarding the underlying pathophysiological mechanisms that cause headaches, regarding the unique aspects of pediatric and adolescent headaches and in regards to their evolution into headache disorders in adults. Most of our current knowledge is driven from extrapolations from studies that were conducted with adult patients.
Children and adolescents are very different than adults in regards to their rapid growth, significant development, and psychological changes that happen during this time of life. Thus, findings from studies conducted on adults need to be validated for the pediatric age group. This article will discuss primary headache that do not require any laboratory or imaging evaluation. In some instances, though, when the treating physician suspects a non-primary origin of headache further investigation may be warrant. If any of the following features are present, one may consider evaluation: new onset of headache, changes in a stable headache pattern, headache that changes with posture, first onset of headache prior to 3 y of age, headache awakening the patient at night. In case of any abnormal neurological symptoms or signs, trauma, or a history of malignancy-further investigation is recommended.