Migraine Headache — Differential Diagnosis — Clinical Pathway: Emergency and Inpatient

Differential Diagnosis

Most headaches in children are associated with infections, trauma or tension and resolve with acetaminophen/ibuprofen, hydration, rest/relaxation, or targeted treatment for specific infection. Serious causes of headache, such as tumor, intracranial hemorrhage or hypertension, and CNS infections are very rare. Clinical judgment must be used to assess need for further diagnostic evaluation.

SNOOPY: Snoop for Secondary Headache

S	Systemic Disease History of malignancy or tumor History of congenital heart disease Immunosuppression or immune deficiency Hematologic – thrombophilia, thrombocytopenia, coagulopathy or sickle-cell disease Genetic disease with predisposition Recent history of head trauma Signs of Systemic Disease Constitutional – weight loss, fever, fatigue, malaise, morning vomiting or recurrent vomiting without cause Infectious – sinusitis, encephalitis/meningitis, tickborne Rheumatologic – arthritis, rash
N	Neurologic Signs Altered mental status Papilledema Focal neurologic findings New seizure
O	Onset Sudden Thunderclap headache – may signal vascular cause
O	Occipital Location May be risk factor for secondary headache
P	Progressive Chronic or acutely progressive pattern Precipitated by Valsalva Cough or sneeze triggering a headache may signal increased or decreased ICP Positional Worse lying down, awakens patient at night when previously no headache, or severe upon awakening may signal increased ICP Persistently worse with standing may be dehydration, decondition, low blood pressure, or low ICP
Y	Years < 6 Risk factor for secondary headache (may be due to limited ability to describe headache)

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Migraine Headache — Differential Diagnosis — Clinical Pathway: Emergency and Inpatient

Differential Diagnosis

SNOOPY: Snoop for Secondary Headache