I have a headache!

 

So your young teenage patient comes in the office with a primary complaint of headache. This is something that happens very frequently.  In fact, headache is in the top 5 diagnoses for children and teens, occurring in 75% of teens and 25% of younger children.  Kids miss school, lose time with friends and in activities.  Family life can be significantly disrupted by headaches.  Everyone in the family has decreased quality of life, and concurrently increased environmental stress.

And with this complaint, there are many things to think about. Is this a primary headache, such as migraine, tension-type, or new daily persistent headache? Is this a secondary headache, such as a headache caused by something serious (brain tumor, brain bleed or meningitis), or less serious (allergies, sinus infection, virus)? Is this the first time your patient has complained of headache or the 20th time? Are there any pre-existing comorbid conditions?   The most important thing is to distinguish between primary and secondary headaches, and then go from there.  You absolutely don’t want to miss that secondary headache diagnosis.

You decide that your patient is constitutionally well, has no signs of serious illness, injury, or viral infection. This is most likely a primary headache. And now the fun begins!

Being a provider for patients with headaches is like being a detective. And it helps if your patients and families join you in your detective work.   I always talk with families about their role, especially with data collection, because good data helps guide care and interventions.  It also encourages the partnership between provider and family, building that relationship.

One of the hardest things about being a headache patient is that it’s an invisible affliction.  Nothing is more important to a headache patient than having a provider who understands, is supportive and knowledgeable about their health issues. It’s the ultimate key to improvement in health outcomes and lifestyle changes.

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