Ann Child Neurol.  2024 Apr;32(2):122-129. 10.26815/acn.2023.00332.

Clinical Analysis and Red Flag Signs in Pediatric Headache According to Age

• Jo YH
• Lee YJ
• Shin D
• Lyu SY
• Kong J
• Lee YJ
• Nam SO
• Kim YM

• KMID: 2554109
• DOI: http://doi.org/10.26815/acn.2023.00332

Abstract

Purpose
The clinical characteristics of headaches vary by age among pediatric patients. Red flag signs are key factors in differentiating secondary headaches and should be considered in the context of the patient’s age.
Methods
This study involved a retrospective chart review of pediatric patients presenting with headaches. Patients were categorized by age into three groups: pre-school age (under 6 years), school-age (6 to 12 years), and adolescence (over 12 years). Demographic data, headache characteristics, laboratory findings, and neuroimaging results were evaluated. Overall, 17 potential red flags were assessed.
Results
A total of 687 patients were included, of whom 102 were of pre-school age, 314 were school-aged, and 271 were adolescents. The frequency of overweight/obesity was found to increase with age. The pre-school age group experienced a shorter period from symptom onset to presentation and a briefer duration of pain. In contrast, adolescents displayed a longer period from symptom onset, a greater frequency of headaches occurring at least three times per week, and a higher rate of headache episodes lasting over 3 days. Children under 6 years old were more commonly diagnosed with secondary headaches than older children. Across age groups, secondary headaches were suspected when systemic symptoms such as fever were present, when the headache had a sudden onset, when the patient responded poorly to medication, or when abnormal neurological signs and symptoms were observed.
Conclusion
The clinical features of pediatric patients vary by age group. Clinicians should consider red flag signs in the context of patient age and individual characteristics.

Keyword

Headache disorders; primary; Headache disorders; secondary; Risk factors; Pediatrics