Historical Overview of Pediatric Headache

Headache is one of the most common, yet most difficult, concerns that present in general pediatrics. The reason for this is that there are countless types of headaches, some of which are quite concerning and can lead to grave consequences if left undiagnosed or untreated. Fortunately, for the vast majority of children and adolescents with headaches, they have headaches that while may be troublesome are not dangerous. The difficulty for a primary provider in pediatrics is identifying those needles in the haystack while continuing to treat the masses or in this case their patients with headaches who present from well-child checkups to acute sick visits. Within this text, we will help the general pediatric provider work through a pediatric headache patient by helping create a foundation of knowledge of headache in general through time from the beginnings of where headache started to where we are today with numerous headache subtypes laid out through a classification system. To assist the primary provider, here we will work through the epidemiology to better explain why headaches may present, the background of headache, and its evolution over time. An introduction to the clinic visit as well as where to go with these children and adolescents in terms of evaluation and treatment will also be introduced here, but will be discussed in more detail in later sections. To further assist primary pediatric providers with their headache patients, this text will review the most common types of primary headaches seen in children and adolescents as well as some of the more common types of chronic daily headaches seen in pediatrics. A comprehensive review of the clinic visit as well as the recommendations regarding workup and evaluation will follow. Neurological, psychiatric, as well as general comorbidities that are commonly seen with pediatric headache patients will then be discussed before leading into a comprehensive review of a multitiered treatment approach to pediatric headache. Finally, we will look at how to think about the transition into adulthood for these adolescents before concluding with the future of pediatric headache.