Persistent/recurrent headache

Persistent/recurrent headache

Reassure

  • Persistent headache on most days over a four week period
  • No worrying features
  • No associated symptoms
  • No associated high risk conditions
  • Normal neurological examination

Review/refer

  • Headache duration less than four weeks
  • No worrying features
  • No associated symptoms
  • No associated high risk conditions
  • Normal neurological examination

Scan

  • Headache with worrying features
  • Headache with abnormal neurological examination
  • Headache with associated high risk condition
  • Headache with one or more other symptoms from symptom checklist

Diagnostic pitfalls

  • Delayed diagnosis has occurred when a complete reassessment is not undertaken with a change in headache type in a known sufferer of migraine or tension headaches

Examination/assessment

  • Determine duration and characteristics of headache
  • Ask specifically about associated symptoms and risk factors:
    • Personal or family history of a brain tumour
    • Leukaemia
    • Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation
    • Neurofibromatosis types 1 and 2
    • Tuberous Sclerosis
    • Li Fraumeni Syndrome
    • Family history of colorectal polyposis
    • Gorlins Syndrome
    • Other familial genetic syndromes
  • Neurological examination (include assessment of vision (including acuity), gait and coordination)
  • Plot growth in all children
  • Plot head circumference in children under two
  • Plot pubertal status if applicable

Worrying features

  • Persistent headaches that occur on waking or wake a child from sleep
  • Headache associated with confusion/disorientation/reduced consciousness/pervasive lethargy
  • Persistent headache in a child younger than four years
  • Headache with other neurological symptoms or signs