Certain types of headaches need to be evaluated quickly by your pediatrician. These include headaches that are severe and have not been experienced before, headaches that are increasing in frequency and severity and causing alteration in daily activities, headaches associated with nausea or vomiting without a prior history of similar headaches and those headaches with a morning pattern that wake a child during the night. For other types of headaches that do not have any of the above features schedule a non-urgent visit with your pediatrician to obtain a thorough history, including a family history review, and perform a comprehensive physical examination. A subsequent visit to an ophthalmologist to look for any eye problems may be arranged but is not always needed if there are no vision complaints and the routine eye examination done in your pediatrician’s office is normal.
If your child sees the ophthalmologist their vision and refraction will be tested as well as eye alignment to look for any strabismus. Some types of strabismus, particularly convergence insufficiency, can cause eye strain with reading. A slit lamp examination will also be done to look for uveitis, ocular inflammation, glaucoma and other causes of referred pain that comes from the eye but is referred to the head.
While performing the examination the ophthalmologist will looks at the optic nerve and retina for changes due to increased intracranial pressure, hypertension and diabetes that could be related to head pain.
In children it is uncommon to find any of the above problems. The next step is always to return to your pediatrician to seek further specialty advice from a pediatric neurologist if the headaches continue. If possible it is always best to see a pediatric ophthalmologist or an ophthalmologist who has been trained specifically in the care of children.