⚠️ Red Flags – Increased ICP
• Headache on awakening or awakens from sleep
• Worse with cough, straining, Valsalva, position change
• Vomiting (especially early morning)
• Altered mental status, personality change
• Focal neurologic deficits, papilledema, sixth nerve palsy
🩺 Migraine
• Family history positive (motion sickness, cyclic vomiting)
• Throbbing/pulsating quality, moderate-severe
• Nausea, vomiting, photophobia, phonophobia
• Aura (visual, sensory) in up to 30%
• Relief with sleep
📋 Tension-Type Headache
• Most common headache type in children
• Pressing/tightening quality, non-pulsating
• Mild to moderate, bilateral, band-like
• No nausea/vomiting, may have mild photophobia or phonophobia
• Not aggravated by routine physical activity
🩺 Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
• Young obese females, papilledema, CN VI palsy
• Elevated opening pressure, normal CSF, normal imaging
• LP diagnostic and therapeutic (temporary relief)
• Treatment: acetazolamide, weight loss, optic nerve sheath fenestration
📌 Decision strategy: Headache awakening child from sleep = red flag for tumor or increased ICP. MRI preferred for structural lesions; CT for acute trauma. Family history of migraine is protective (absence increases concern for space-occupying lesion).