Dr. Elías Jiménez
F.
There's a belief that children cannot suffer from cephalea,
so when it occurs, parents get anguished and fearful.
This is an erroneous belief, since cephalea does not
only occur among children older than 5 years, but it is also a common
symptom. Some authors have reported that the incidence of cephalea in
school children can reach up to 59%, but in only 10% of the cases it is
a frequent symptom.
The causes for cephalea in children are very varied.
The most frequent ones are those related to migraine (either accompanied
or not by visual manifestations), tension, and the ones with no definite
cause. These three cover more than 90% of the cases.
In the rest of the patients cephalea is due to multiple
factors such as sinusitis, dental problems, difficulty with the eyesight,
depression, and occasionally serious illnesses like tumors or vascular
malformations.
The pediatrician, who is going to attend the child suffering
from cephalea, should know certain things about it. For example, he should
know the frequency with which it occurs, its intensity, the time of the
day when it happens (if it's during the day when the child is at the school,
or does the child wake up at night from the pain). He should also be aware
if there are other symptoms, such as vomit, seizures, motor or eyesight
problems, associated with it. With this information and with a detailed
clinical exam, the pediatrician will be able to establish the cause of
the cephalea, how to prevent it and the appropriate treatment.
In the majority of the cases a test like a MRI or CT
scan is not necessary, since they would probably show adequate results.
Only for a child who has neurological manifestations that have no explanation
this tests would be justifiable. It is necessary to maintain a firm position
against these tests when there is no need for them, even when the parents
pressure us to do them.
If the cause is established with precision, the treatment
will be more adequate, focusing on decreasing the family's anxiety, the
use of special analgesics, or the use of special migraine medicine, psychological
support, and sometimes an appropriate diet.
