Headache is a common presentation among children, and is classified as either primary or secondary, with secondary headaches caused by underlying pathology. Tension type headache and migraine are common primary causes. This article discusses common primary headaches seen in children and the management.

Headache is classified as either primary or secondary, with secondary headaches caused by underlying pathology. Once a secondary headache due to serious underlying pathology is ruled out, it is important to use clues in the history to differentiate between different primary headaches so the correct management can be initiated.1 The most common primary headache types in children are migraine and tension-type headaches. Trigeminal autonomic cephalgia (TAC) is rare in children but must be recognised and differentiated from other types as the treatment differs.2 Using clinical scenarios, this article will discuss the management of these headache disorders in children.

An 11-year-old girl presents with a history of headaches for the last 18 months. She was recently diagnosed with dyslexia. The headache occurs most days of the week and is worse during term time. She describes it as frontal and squeezing in nature, typically starting at school after lunch and lasting until evening. She takes paracetamol and ibuprofen every day when she gets home. She is able to do her homework and play with her friends. She denies photophobia, phonophobia, nausea or vomiting. She had a normal optician review last month. There is no family history of migraine. Her neurological examination is unremarkable.

The chronic and non-progressive nature of this girl’s symptoms, combined with normal clinical examination, suggests that primary headache is the most likely diagnosis. Table 1 lists features of headache histories differentiating between primary headache disorders. The absence of photophobia, phonophobia and limitations in daily activities all lend support to the diagnosis of tension headache. …