Patterns of headaches
Pattern 1 is known as chronic non- progressive. It is the pattern seen with the primary headaches known as tension-type. Although tension type headache can indeed be psychogenic in its aetiology, many other factors can be involved.
Pattern 2 is known as chronic progressive. This is a red flag pattern and should trigger prompt referral for investigation. It is seen in Hydrocephalus, Brain Tumour, Brain Abscess and Benign Intracranial Hypertension.
Pattern 3 is typical of migraine; further classification will depend on other symptoms noted in the headache diary.
Pattern 4 is acute on chronic non-progressive and the possibility of co-existing migraine with background tension headache should be considered.
Treatment of headaches in children
The treatment of all headaches will rely on identifying the type and any aetiological factors. Secondary headaches will be addressed by treating the underlying cause and almost all will need referral for investigation and treatment. One tip would be to take occipital headaches more seriously – in children it is unlikely to originate in the neck and although may simply be a tension-type headache it is a less common site than frontal or parietal pain.
Primary tension-type headaches may be treated with simple measures (including no analgesia). High chronic use of analgesia can in turn lead to difficulties with both analgesic headache and withdrawal headaches. The treatment may need to be tailored to the individual (e.g. relief of school anxiety, home stress etc.) or intermittent simple analgesia.