Primary Care Clinical Pathway for Evaluation
and Management of Child with Headache

No/Low Concern for Secondary Headache

Normal neurologic exam
Consider Primary Headache
Neuroimaging not routinely recommended for
child with recurrent headache and normal exam
Refer to ED
Urgent Neurology Consult
  • Indications
    • Persistent confusion or altered consciousness
    • Abnormal neurologic exam
    • Associated seizures
    • Severe (thunderclap) headache
    • Increased intracranial pressure signs/symptoms
    • Meningeal signs
  • PCP follow-up:
    • Assess response to treatment
    • Reassess symptoms
  • Refer to Neurology as needed for:
    • Unclear diagnosis
    • Inadequate treatment response
    • Headache symptoms worsening
    • New or changing symptoms
Outpatient Evaluation
Brain MRI with and
without contrast Indicate in the order: contrast given at radiologist’s discretion
PCP follow-up to reassess symptoms, labs as indicated
Refer to Neurology
Indicate urgency of follow-up