![]() The reported prevalence of headache among schoolchildren varies greatly, from 5.9 to 82%, depending on the definition criteria. There is a high incidence, prevalence, and individual and societal cost of headache disorders in children and adolescents. ![]() A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment, bearing in mind that children with headache are more likely to experience psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms and this creates an important healthcare problem for their future life. ![]() Thus, the differential diagnosis between primary and secondary headaches rests mainly on clinical criteria. Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated with severe vomiting and headache associated with straining. In secondary headache disorders, headache is the symptom of identifiable structural, metabolic or other abnormality. migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalgias). In a primary headache disorder, headache itself is the illness and headache is not attributed to any other disorder (e.g. The electroencephalogram and other neurophysiological examinations are of limited value in the routine evaluation of headaches. Subjects who have any signs or symptoms of focal/progressive neurological disturbances should be investigated by neuroimaging techniques. The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. Moreover, the possible role of psychological factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. Headache is the most common somatic complaint in children and adolescents.
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