Pediatric emergency medicine trisk 1144 1144
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FIGURE 59.1 Approach to the diagnosis of headache.
After general health issues are covered, the clinician should then obtain a
complete history regarding the headache itself. As with many illnesses, the cause
of headaches can usually be diagnosed with a high degree of accuracy solely
based on history; the physical examination is often merely confirmatory. One of
the more important points to investigate is the mode of onset. A headache that
starts abruptly and causes extreme pain may represent a vascular event such as a
ruptured arteriovenous malformation, whereas a headache with a more gradual
onset would be inconsistent with this diagnosis. It is sometimes useful to question
the patient about the severity of the pain, although in younger children, this
