Primary Care Clinical Pathway for Evaluation
and Management of Child with Headache
No/Low Concern for Secondary Headache
Normal neurologic exam
Consider Primary Headache
Neuroimaging not routinely recommended for
child with recurrent headache and normal exam
Neuroimaging not routinely recommended for
child with recurrent headache and normal exam
- Lifestyle Modifications
- Acute Treatment
- NSAIDs
- Triptans
- Antiemetics
- Preventative Treatment
- Lifestyle Modifications
- NSAIDs
Refer to ED
or
Urgent Neurology Consult
or
Urgent Neurology Consult
- Indications
- Persistent confusion or altered consciousness
- Abnormal neurologic exam
- Associated seizures
- Severe (thunderclap) headache
- Increased intracranial pressure signs/symptoms
- Meningeal signs
- PCP follow-up:
- Assess response to treatment
- Reassess symptoms
- Refer to Neurology as needed for:
- Unclear diagnosis
- Inadequate treatment response
- Headache symptoms worsening
- New or changing symptoms
Outpatient Evaluation
Brain MRI with and
without contrast Indicate in the order: contrast given at radiologist’s discretion
without contrast Indicate in the order: contrast given at radiologist’s discretion
and/or
PCP follow-up to
reassess symptoms, labs as indicated
and/or
Refer to Neurology
Indicate urgency of follow-up
Indicate urgency of follow-up
Posted: October 2023
Editors: Clinical Pathways Team
Editors: Clinical Pathways Team