Providing Care for Children With Headache

Headaches in children are common, and care has traditionally been guided by anecdotal evidence. However, clinical pathways may be the future of primary care for headache in children, according to Elizabeth Rende, DNP, CPNP‐PC, PMHS‐BC, FAAN with Duke Pediatric Neurology.

In a session presented at the National Association of Pediatric Nurse Practitioners national conference in New Orleans, Rende said up to 85% of pediatric patients have had a significant headache event by age 15 years.

For children with primary headache, the desired outcomes include correct diagnosis of the type of headache, appropriate diagnostic testing, and management of headache pain, according to Rende.

Secondary headaches are indicative of another issue, such as dehydration. The most common secondary headaches are related to infections, head trauma, and tension. These types of headaches are managed by treating the underlying cause.

Initial care typically begins at home with any headache, Rende said, and can extend to other facets of a child’s life. In some instances, children are missing school days and extracurricular activities, due to more painful headache.

“You may not hear about a child’s headache until it starts to interfere with quality of life,” she added.

In cases of severe acute onset of headache, an emergency department may serve as the initial point of care.

Headaches that continue and worsen in severity and frequency may be reported by parents as a chronic condition. However, there are no clear guidelines about when to refer a child with headache to a pediatric neurologist, Rende said.

In addition, access to this type of specialty care is limited with typically long wait times and few pediatric neurologists to whom patients can be referred. “Access to pediatric neurology can be challenging,” said Rende.

Given the challenges associated with diagnosing a headache’s cause, clinical pathways can serve as road maps for providers. These treatment plans are beneficial for translating best clinical practice guidelines and evidence-based practice, according to Rende. She said clinical pathways also indicate an order of treatment interventions for reaching patient outcome goals.

More than 80% of hospitals utilize clinical pathways for at least 1 treatment intervention. They depend on the resources available at these health care facilities, and that which are current at the time of publication.

In addition to serving as a guide for assessing a headache and managing the condition, clinical pathways can be customized for each patient according to the provider’s professional judgement. According to Rende, although clinical pathways aid in medical decision making and standardize care for populations with certain diagnoses, including headache in children, there is not just 1 way to implement them.

“There are so many determinants that can develop and influence a clinical pathway,” said Rende. “(And) it will be modified for each patient you care for.”

For children with primary headache, the desired outcomes include correct diagnosis of the type of headache, appropriate diagnostic testing, and management of headache pain for home, school, and extracurricular activities.

Use of clinical pathway should improve headache guideline adherence, which leads to better patient outcomes.

“We may not be able to take away the pain entirely, but we can improve the quality of life,” said Rende. “Our goal is to decrease disability.”