Volume 37, Issue 6 , Pages 205-206, July 2007
Foreword
Article Outline
It is not uncommon for a patient’s parents to worry that the most likely cause for their child’s headache is due to a serious diagnosis. As clinicians we evaluate children with headache on a regular basis and we must be vigilant so as not to miss potentially life-threatening headaches. Fortunately these are rare and we are usually able to reassure parents about the self-limiting nature of these headaches. But as Dr. Donald Lewis notes, we must be able to reassure ourselves first and we should remember that a thorough history and physical examination most often will suffice in the evaluation of this child. In this issue of Current Problems in Pediatric and Adolescent Health Care, Dr. Lewis clearly reinforces what all of us learned in our first physical diagnosis course - that in most cases a thorough history and complete physical examination IS sufficient to establish the correct diagnosis and that additional laboratory and radiologic studies are not necessary.
As the senior author on the American Academy of Neurology’s practice parameter on the evaluation of children and adolescents with recurring headaches (available at: www.aan.org), Dr. Lewis provides us here with a clear and straightforward approach to the child with headache and the concerned parents. His template for the appropriate evaluation discusses the critical questions necessary in the requisite history to differentiate the various causes of headache. He also highlights the “red flags” not to be missed and the components of the physical examination deserving special attention so as not to miss serious pathology.
In this review, Dr. Lewis emphasizes the value of a headache diary. Most often we initially are in the situation of evaluating a patient’s symptoms based on recall of prior episodes. These retrospective accounts potentially suffer from lack of detail, specificity and accuracy. The invaluable headache diary seeks to prospectively document information on the quality of the signs, symptoms and level of disruption from normal activity experienced by the patient. Evidence from the adult literature suggests that the use of a structured diary enhances communication from both the patient and clinician’s perspective and also improves the patients’ satisfaction with treatment as well as the clinicians’ abilities to assess differences in pain intensity and patient disability. The majority of physicians studied also believed it influenced their therapeutic decision-making.1 It would not be a stretch to consider similar outcomes likely in pediatric patients and their parents.
Dr. Lewis presents the headache overview from the perspective of the dichotomy between primary and secondary headaches. His primary focus is on the migraines, tension-type headaches, chronic daily headaches and other primary headache syndromes. There is also a thorough and helpful discussion on the pharmacologic and non-pharmacologic treatments available to help organize our understanding of the often conflicting headache classifications and understudied treatment strategies in children versus adults.
Schor has demonstrated that not only is neuro- imaging obtained more frequently but also prophylactic therapy initiated less frequently than recommended by published guidelines.2 Hopefully this issue of CPP will help you sort these issues and prevent your developing your own headache when you hear your next patient’s chief complaint is “headache.”
References
PII: S1538-5442(07)00021-1
doi:10.1016/j.cppeds.2007.03.006
© 2007 Mosby, Inc. All rights reserved.
Volume 37, Issue 6 , Pages 205-206, July 2007
