Managing Headaches in Pediatric primary Care: Key Takeaways from AAP 2025
Headaches are a common concern in children and adolescents, significantly impacting their quality of life, academic performance, and emotional well-being. Approximately 10% of children experience migraines, leading to both individual suffering and significant healthcare costs and lost productivity. At the recent American Academy of Pediatrics (AAP) 2025 conference in Denver,Dr. Meghan Candee delivered a presentation outlining practical, current strategies for headache management in primary care settings.
Essential Considerations for Pediatricians
A crucial first step is differentiating between primary headaches – like migraine and tension-type headache – and secondary headaches, which may indicate a more serious underlying condition. Migraines typically present as pulsatile, moderate to severe pain, affecting one or both sides of the head, and are frequently enough accompanied by nausea, vomiting, sensitivity to light (photophobia), and sensitivity to sound (phonophobia). Tension-type headaches are generally milder, bilateral, and feel like pressure, without worsening with physical activity.
The presence of an aura – visual, sensory, or language disturbances - preceding the headache can aid in diagnosis. Migraine prevalence tends to increase after puberty,particularly in girls,and can develop into chronic forms.Therefore, recognizing concerning patterns is vital, including sudden onset, a change in the usual headache pattern, or accompanying neurological symptoms.
When to Consider Imaging
The decision to order imaging tests should be guided by specific clinical criteria. Red flags that warrant inquiry include acute onset of severe pain, age under 3 years, lack of family history of headaches, a persistent aura, altered consciousness, neck stiffness, symptoms that change with position, or changes in gait. The “SNOOP” mnemonic (Sudden onset, Neurologic symptoms, One headache feature unusual, Older age, Progressive headache, Positional headache) can be a helpful reminder of these alarm signs.
Treatment Approaches
Acute headache treatment should be initiated promptly, prioritizing both effectiveness and safety. Over-the-counter pain relievers can be effective for many cases. However, triptans - such as Rizatriptan and Zolmitriptan - are safe and approved for children aged 6 and older. If headaches occur more than twice a week or significantly interfere with daily functioning, prophylactic medication should be considered.Options include topiramate, amitriptyline, propranolol, or supplements like riboflavin and magnesium.
Non-pharmacological preventative measures are equally crucial. A practical approach involves setting SMART goals: ensuring regular sleep, adequate hydration and nutrition, frequent physical activity, stress relaxation techniques, and identifying and managing headache triggers. Overuse of medication can actually worsen headaches, so it’s essential to educate families about limiting the use of painkillers and triptans.
Key Takeaways for Practice
* Actively screen for red flag symptoms during all headache evaluations.
* Educate families on the importance of establishing healthy habits with realistic, achievable goals.
* Consider prophylactic medication when headache frequency or impact is high.
* Emphasize the need to avoid overuse of pain medications to prevent medication-overuse headache.
* Be mindful of periodic childhood syndromes, especially in patients with a family history of migraine.
