When to Seek Medical Care, Questions to Ask the Doctor, and Diagnosis
Parents should take children with severe headaches to see a doctor. The doctor will ensure that no life-threatening underlying condition is responsible. He or she will also provide a diagnosis, reassurance that no serious underlying illness is present, and a plan for effective pain treatment.
Questions to Ask the Doctor
Writing down specific questions before a medical appointment is a good idea. Parents should feel free to take notes and/or make an audio recording of the visit.
The purpose of the first appointment is to find out what kind of headache the child has. If a diagnosis of migraine headache is confirmed, the doctor should spend time explaining exactly what that means for the child and for the parents or caregivers.
Education is often the most important part of the visit. A review of potential trigger factors, how to treat the headache pain at the time of the attacks, and whether a preventive drug is needed are important issues that should be addressed.
Migraine Headache in Children Diagnosis
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 (swelling of the structures and tissues of the retina), cutaneous lesions (skin changes), cognitive (thinking) changes, or asymmetric signs (for example, weakness on one side of the body).
The doctor will order laboratory studies (lab tests) to rule out other causes for those people with headache that might have a non-migrainous reason for their headaches.
Typically, imaging studies are unnecessary in children with a long-term (more than 6 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 (swelling of the structures and tissues of the retina).
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 certain other conditions.