A Visual Guide to Migraine Headaches Slideshow Pictures Headache and Migraine Triggers Slideshow Pictures Take the Migraines Quiz

Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Exams and Tests

Doctors evaluate children who have headaches by performing a thorough general physical examination and a detailed neurologic examination (an examination of the brain and nerve functioning). All findings should be distinctly normal.

Doctors perform or order appropriate additional evaluations and tests if the child has abnormal vital signs, nuchal rigidity (stiff neck), cranial nerve (nerves in the head) abnormalities, macrocephaly (an abnormally large head), bruits (abnormal body sounds), papilledema (swollen eyes), cutaneous lesions (skin changes), cognitive (thinking) changes, or asymmetric signs (for example, weakness on one side of the body).

Laboratory studies

The doctor will order laboratory studies (lab tests) for only the small percentage of people with headache might have a nonmigrainous reason for their headaches.

Imaging studies

Typically, imaging studies are unnecessary in children with a long-term (more than six months) history of headaches, normal neurologic examination results, and no seizures. An abnormal imaging result is very rare in a person meeting these criteria. The doctor will consider imaging studies in everyone with a history of seizures, recent head injury, significant change in the character of the headache, focused brain/spinal cord/nerve deficits, or papilledema (swollen eyes).

Diagnostic procedures

A lumbar puncture (spinal tap) will probably be performed if the doctor suspects meningitis (inflammation of the membranes of the brain and/or spinal cord), encephalitis (inflammation of the brain), subarachnoid hemorrhage (bleeding in the brain membranes), or high-low pressure syndromes are possible. When appropriate, the doctor may look inside arteries of the head and neck with a tiny camera, a procedure called endoscopy.