Pediatric Headache Red Flags and What They Might Indicate
If a pediatric patient frequently complains of headaches or other discomfort, it is important to ask about and monitor concurrent symptoms. While the following symptoms could suggest any number of conditions, they require special attention if occurring in combination with frequent headaches.
- May indicate: infections, meningitis (minor to see areas)
- May indicate: component of chronic migraine, brain tumors
Sudden onset/thunderclap headache
- May indicate: intracerebral hemorrhage, RCVS among others
- May indicate: intracranial bleeding, increase ICP
Onset in sleep – early morning
- May indicate: intracranial lesions (diurnal pattern-primary headaches, sleep apnea/sleep disorders also)
Headache worsens while upright
- May indicate: intracranial hypertension or orthostatic headaches
Headaches worsens while supine
- May indicate: increase intracranial pressure due to any reason, IIH included
Focal neurological symptoms
- May indicate: secondary headache (ataxia, papilledema, visual disturbances, ocular movement abnormalities, changes in reflexes, seizure, acute changes in personality/behaviors/cognition/etc.)
Precipitated by Valsalva
- May indicate: intracranial pressure/abnormalities
Triggered by cough + brain stem/cerebellum/cervical spinal cord dysfunction
- May indicate: Chiari malformation
If your pediatric patient has significant changes in pattern, type or characteristics of his/her headaches, it may indicate a progression of a disorder or new onset of a concern.
Some studies indicate that young patients (less than 5 years, sometimes less than 7 years) have more serious headaches.
It is also important to remember that if a child does not have a family history of concurrent headache symptoms, he/she is at a higher risk of having a serious or secondary cause of headache.
For headache concerns in your pediatric patients, please contact Boys Town Headache Clinic at