Headache is a frequent symptom in children but deciding whether or not it is due to a serious problem can be a difficult task, even for the most experienced healthcare provider. A detailed history, physical examination, and appropriate tests are essential in determining the correct diagnosis. Fortunately, the large majority of children complaining of headache do not have any serious underlying disease as a basis for their complaints. When taking a history, which is the most important factor in making an accurate diagnosis, it is necessary to question children and parents together to elicit signs of emotional friction that may provide a clue to reasons for the headache. It is also helpful to talk with the patient without parents present to address any issues the child did not discuss in front of parents. Equally important is a thorough and complete neurological examination to identify any variations from normal. As in adults, headache in children can be classified into two types: primary or benign (migraine, tension-type) and secondary (due to underlying, organic causes).

Exertional headaches are a group of headache syndromes, which are associated with some physical activity. These headaches typically become severe very quickly after a strenuous activity such as weight lifting or sexual intercourse. Exertional headaches can, in some instances, be a sign of abnormalities in...