Pediatric emergency medicine trisk 1137 1137
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described by the patient or parents (see Chapter 97 Neurologic Emergencies ).
Often, a strong family history of migraines is present. For the emergency
physician, the main issue with migraine patients is generally pain control, because
the diagnosis is already known. However, a significant change in the quality,
severity, or timing of headaches in these patients may represent a separate and
potentially more serious problem. In such cases, the clinician should not be
dissuaded by the existing diagnosis from pursuing an appropriate workup as
indicated.
Headaches accompanying fever are also believed to be mediated by vascular
effects. Because fever is such a common symptom, this is probably the most
common cause of headaches in pediatric patients seen in the ED. Hypertension,
although rare, is another possible cause of vascular headaches in children.
Renovascular disease leading to hypertension can in some instances be a lifethreatening etiology. Additionally, children and teenagers may have an
undiagnosed coarctation of the aorta leading to hypertension and associated
headaches. Because of its rarity, this condition is easily misdiagnosed.
Hypertension causes not only global changes in cerebral vasculature, but also
possibly a component of increased intracranial pressure (ICP) that leads to
headache.
