Child Headache Evaluation in Kathmandu —— When Parents Should Worry

Headache in children is common —— studies suggest 50——80% of children experience headache by age 15. Most headaches in children are primary (migraine or tension-type) and respond to lifestyle changes, sleep regularity, hydration and appropriate analgesic use. However, certain features signal the need for neurological evaluation rather than reassurance.

How common childhood headache is: Population studies show headache prevalence increasing from approximately 20% at age 5 to over 50% by adolescence. Tension-type headache is the most common type in school-age children, while migraine becomes more prevalent in adolescence. Recurrent abdominal pain in children with a family history of migraine may represent an abdominal migraine equivalent.

Dr. Jitendra Prasad Yadav — consultant neurologist & headache specialist at Kathmandu Neurology Clinic & Cognitive Center provides evidence-based evaluation for migraine.

Tension-type headache in children: Typically bilateral, pressing or band-like, mild to moderate, not worsened by routine activity, without nausea or significant photophobia. Triggers include academic stress, social difficulties, screen fatigue, dehydration and poor sleep. Management focuses on sleep hygiene, hydration, regular meals, stress management and limiting analgesic use to avoid medication-overuse headache.

Migraine in children: Often unilateral or bilateral throbbing, moderate to severe, lasting 2——72 hours, with nausea ± vomiting, photophobia and phonophobia. Children may describe pain as "my head hurts" and prefer to lie in a quiet dark room. Aura may occur with or without headache. Migraine in children commonly runs in families. Management includes acute treatment (paracetamol or ibuprofen taken early), trigger identification and preventive discussion when frequency disrupts school or activities.

Red flags in children requiring urgent evaluation: Progressive worsening headache over weeks, morning headache or vomiting (especially on waking), headache that wakes the child from sleep, new headache after head injury, headache with fever and neck stiffness or confusion, headache with seizures, personality or behavioural change noticed by parents or teachers, new visual changes (double vision, visual loss), progressive neurological deficit (weakness, numbness, walking difficulty), and headache in a child under 5 years with atypical features. These features warrant same-day or next-day neurological assessment rather than watchful waiting.

When to see a neurologist: Headache occurring more than 4 times per month with disability, headache that does not respond to simple measures, any red flag feature, diagnostic uncertainty after primary care evaluation, or parental concern that something is wrong despite normal examination. At Kathmandu Neurology Clinic & Cognitive Center, Dr. Jitendra Prasad Yadav (NMC 8029) evaluates children with headache using age-appropriate history, neurological examination and selective investigation. Diagnosis is clinical —— imaging is not routine without red flags.

What to expect at consultation: Detailed history including birth, developmental milestones, school performance, family headache history, sleep pattern, screen time, diet, and exact headache description. Neurological examination including vision, eye movements, facial sensation, strength, coordination, gait and reflexes. Investigations (MRI, blood tests) are ordered only when examination or history suggests a secondary cause.

Bring school notes on frequency and impact, a simple headache diary, and both parents if possible. For emergencies —— sudden severe headache with vomiting, neck stiffness or altered consciousness —— go to the nearest emergency department immediately.

This article is educational and does not replace individual medical advice.