{"id":28131,"date":"2026-06-01T08:18:51","date_gmt":"2026-06-01T07:18:51","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=28131"},"modified":"2026-06-12T08:10:55","modified_gmt":"2026-06-12T07:10:55","slug":"headachepaeds","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/headachepaeds\/","title":{"rendered":"Headache (Paediatric)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Any child presenting with a new or changed headache should be assessed for red or amber flags (listed in the tables below) through history and examination. Examination should include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growth (up to date trend of height and weight <em>and OFC if &lt;2 years old<\/em>)<\/li>\n\n\n\n<li>HR and BP (if correct cuff available)<\/li>\n\n\n\n<li>Neuromotor, cerebellar and cranial nerve examination<\/li>\n\n\n\n<li>Fundoscopy is limited in the GP setting so advise an optician appointment (ideally within 1 week)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">If indicated from the history, consider also doing a pubertal status, ENT or MSK neck examination.<\/p>\n\n\n\n<figure class=\"wp-block-table aligncenter\"><table><thead><tr><th>Red Flag<\/th><th>Possible Intracranial pathology&nbsp;<\/th><th>Referral&nbsp;<\/th><\/tr><\/thead><tbody><tr><td>\u2022 Wakes through the night with headache or present on waking<br>\u2022 Aggravated by increased pressure e.g. sneeze\/bending down<br>\u2022 Recurrent and\/or early morning vomiting&nbsp; <br>\u2022 Papilloedema <br>\u2022 Infant with sun-setting sign (failure of upward gaze)&nbsp; &nbsp;<br>\u2022 Increasing head circumference (crossing 2 centiles in &lt;2y old) <br>\u2022 Presence of VP shunt<\/td><td>Raised ICP (intra- cranial pressure)&nbsp;<\/td><td>Urgent same day ED<\/td><\/tr><tr><td>\u2022 Under 4 years of age&nbsp; <br>\u2022 Associated neurology e.g. ataxia&nbsp;<\/td><td>Space&nbsp;Occupying&nbsp;Lesion&nbsp;<\/td><td>Urgent same day ED<\/td><\/tr><tr><td>\u2022 Fever&nbsp;(without signs of URTI or other source of infection) <br>\u2022 Signs of meningism e.g. photophobia, neck stiffness&nbsp;<\/td><td>Meningitis\/Encephalitis&nbsp;<\/td><td>Urgent same day ED<\/td><\/tr><tr><td>\u2022 Headache within 5 days of head injury&nbsp;(that is not helped with simple analgesia)<\/td><td>Traumatic&nbsp;Intracranial Bleed&nbsp;<\/td><td>Urgent same day ED<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table aligncenter\"><table><thead><tr><th>Amber Flags<\/th><th>Possible secondary cause<\/th><th>Referral<\/th><\/tr><\/thead><tbody><tr><td>\u2022 Stigmata of neurocutaneous syndromes e.g. neurofibromatosis and tuberous sclerosis<\/td><td>Space Occupying Lesion&nbsp;<\/td><td>Urgent Neurology OPC<\/td><\/tr><tr><td>\u2022 Delayed\/accelerated puberty<br>\u2022 Teenager with a constant headache&nbsp;<br>\u2022 Progressing headache&nbsp;<\/td><td>Space occupying lesion&nbsp;<\/td><td>Urgent Medical Paediatric OPC<\/td><\/tr><tr><td>\u2022 Poor growth<br>\u2022 High BP<\/td><td>Metabolic \/ Endocrine \/ Renal \/ Other<\/td><td>Medical Paediatrics OPC<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Once red and amber flags have been ruled out then the history can focus on distinguishing which primary headache the child is likely presenting with (see the table below for the distinguishing characteristics).<\/p>\n\n\n\n<figure class=\"wp-block-table aligncenter\"><table><thead><tr><th>Type of primary headache&nbsp;<\/th><th>Characteristics&nbsp;<\/th><\/tr><\/thead><tbody><tr><td>Tension-type headache&nbsp;<\/td><td>\u2022 Mild &#8211; moderate&nbsp;(minimal impact on daily activities)<br>\u2022 Bilateral&nbsp;<\/td><\/tr><tr><td>Migraine&nbsp;<\/td><td>\u2022 Moderate &#8211; severe (causes child to stop activities)&nbsp;<br>\u2022 Bilateral (teenagers may describe it as unilateral)&nbsp; <br>\u2022 +\/- Aura e.g. visual (flickering lights, spots or lines, partial loss of vision), sensory (paraesthesia \/ numbness) or speech disturbance&nbsp; <br>\u2022 Associated nausea \/ vomiting, photo \/ phonophobia&nbsp;<br>\u2022 Family history&nbsp;<\/td><\/tr><tr><td>Cluster headache&nbsp;<\/td><td>\u2022 Rare&nbsp; <br>\u2022 Severe (agitated and pacing the floor)&nbsp; <br>\u2022 Unilateral around the eye&nbsp; <br>\u2022 Associated ophthalmic symptoms (red watering eye, swollen \/ drooping eyelid, constricted pupil) and \/ or nasal congestion, facial sweating&nbsp;<\/td><\/tr><tr><td>Medication overuse headache&nbsp;<\/td><td>\u2022 Taking paracetamol or NSAIDs \u226515 days of the month for \u22653 months&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>In most cases of headache, provided growth is good and in the absence of red and amber flags, no further investigation is required.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.M, A.B, C.H &amp; E.P &#8211; 01-06-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who can refer: <\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">GPs and Advanced Nurse Practitioners.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refer any child displaying red flag symptoms suggestive of intracranial pathology urgently to RHCYP emergency department<\/li>\n\n\n\n<li>Refer any child displaying amber flags suggestive of a secondary cause to Medical Paediatrics \/ Neurology as above<\/li>\n\n\n\n<li>Refer any child whose headache is not controlled with primary care management to Medical Paediatrics<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer: <\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Adolescents aged 16 years or above should be referred to adult services<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer: <\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">SCI gateway.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Edinburgh, East &amp; Midlothian: RHCYP &gt; Medical Paediatrics or RHCYP &gt;Neurology<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">West Lothian: St. John\u2019s Hospital &gt; Paediatrics &gt; LI Basic Sign Referral<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">The following management advice is for primary headaches in children where red and amber flags have been ruled out and a secondary cause is not suspected.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Print the appropriate PIL for your patient (the PIL includes excellent advice on lifestyle management, using a headache diary and relaxation techniques).<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2026\/02\/Tension-headache-information-pack-7-12-year-olds.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Tension Headache Information Pack for 7-12 year olds<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2026\/02\/Tension-headache-information-pack-teenagers.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Tension Headache Information Pack for Teenagers<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2026\/02\/Migraine-information-pack-7-12-year-olds.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Migraine Information Pack for 7-12 year olds<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2026\/02\/Migraine-information-pack-teenagers.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Migraine Information Pack for Teenagers<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Lifestyle and psychosocial management<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Lifestyle habits and psychosocial stressors are important to address as potential triggers or exacerbators of the headaches:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Hydration <\/strong>&#8211; ensure drinking the appropriate fluid volume per day for the child\u2019s age <a href=\"https:\/\/www.bda.uk.com\/resource\/fluid-water-drinks.html\" target=\"_blank\" rel=\"noreferrer noopener\">Fluid (water and drinks) and hydration &#8211; BDA<\/a>. Avoid sugary, fizzy and caffeinated drinks.<\/li>\n\n\n\n<li><strong>Diet<\/strong> &#8211; regular healthy meals (avoid missing meals), avoid artificial flavourings and sweeteners.<\/li>\n\n\n\n<li><strong>Sleep<\/strong> &#8211; ensure getting adequate hours for the child\u2019s age, <a href=\"https:\/\/www.sleephealthfoundation.org.au\/sleep-topics\/how-much-sleep-do-you-really-need\" target=\"_blank\" rel=\"noreferrer noopener\">How much sleep do you really need? | Sleep Health Foundation<\/a><\/li>\n\n\n\n<li><strong>Screen time<\/strong> \u2013 advice is no screen time under 2 years, 1 hour \/ day from 2 \u2013 5 years, no more than 2 hours \/ day over 5 years (of ANY screen).<\/li>\n\n\n\n<li><strong>Stress<\/strong> &#8211; address any home or school stressors, get support from school \/ online resources \/ third sector support \/ CAMHS if appropriate.<\/li>\n\n\n\n<li><strong>Drugs<\/strong> &#8211; ensure you ask about and advise against alcohol, drugs, smoking and vaping in teenagers.<\/li>\n\n\n\n<li><strong>Headache diary<\/strong> &#8211; a helpful way for children and families to identify triggers and helpful for secondary care assessment if referred. <a href=\"https:\/\/migrainetrust.org\/wp-content\/uploads\/2025\/03\/The-Migraine-Trust-headache-diary.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">The-Migraine-Trust-headache-diary.pdf<\/a><\/li>\n\n\n\n<li>If medication-overuse headache is suspected:\n<ul class=\"wp-block-list\">\n<li>Withdraw overused medication gradually over 2-4 weeks<\/li>\n\n\n\n<li>Advise symptoms likely to get worse in short term (for 1-3 weeks) and can take up to 2 months before clear improvement<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>If there is a cervicogenic element to the headache consider home neck stretches and referral to paediatric physiotherapy<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Acute management<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>First line is paracetamol and \/ or ibuprofen. Limit to three days per week to prevent medication overuse headache.&nbsp;<\/li>\n\n\n\n<li>If a migraine is suspected, second line is combination therapy of paracetamol or ibuprofen with a triptan. An anti-emetic such as prochlorperazine can also be considered even in the absence of nausea and vomiting. (see the table below for information on these medication options)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Prophylaxis<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>For the majority of children, focusing on lifestyle habits, psychosocial needs and acute pain management is likely to be sufficient.<\/strong> However, in the minority of children who continue to have regular headaches impacting their quality of life despite this, prophylaxis should be considered. Prophylactic management can be started in the primary care setting.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>There is limited evidence of benefit for prophylaxis treatment in children and this needs to be weighed up against potential harms of side effects.<\/strong> Prophylactic medication should be reviewed after 6 months to consider whether there is ongoing need for continued use.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>For migraines in over 12 year olds, Propranolol is first line. If under the age of 12 years, Pizotifen is a reasonable first line prophylaxis.<\/li>\n\n\n\n<li>For chronic tension-type headaches in 12\u201317 year olds, NICE&nbsp;recommends&nbsp;considering:\n<ul class=\"wp-block-list\">\n<li>a course of 6\u201310 sessions of acupuncture (if families are willing to access this privately)<\/li>\n\n\n\n<li>Cognitive&nbsp;Behavioural&nbsp;Therapy for relaxation techniques. (CBT for headaches is not available under the NHS, however families may consider to access this privately or alternatively you could give resources on relaxation <a href=\"https:\/\/services.nhslothian.scot\/camhs\/wp-content\/uploads\/sites\/55\/2024\/09\/Relaxation-Exercises-CAMHS-V1.0.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PowerPoint Presentation<\/a>)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">See the table below for information to consider when prescribing Migraine medications.<\/p>\n\n\n\n<figure class=\"wp-block-table aligncenter\"><table class=\"has-fixed-layout\"><thead><tr><th><strong>Medication<\/strong>&nbsp;<\/th><th><strong>Licensing and dosing in&nbsp;BNFc<\/strong>&nbsp;<\/th><th><strong>Key considerations<\/strong>&nbsp;<\/th><th><strong>Side effects*<\/strong>&nbsp;<\/th><\/tr><\/thead><tbody><tr><td>Sumatriptan&nbsp;<\/td><td>Licensed &gt;12y nasal route. Off-license oral dosing for &gt;6 years.<\/td><td>Zolmitriptan to be considered if &gt;12 years and headache duration is longer.&nbsp;<\/td><td>Dizziness, fatigue, dry mouth, flushing, tingling of skin.&nbsp;<\/td><\/tr><tr><td>Prochlorperazine&nbsp;<\/td><td>Licensed &gt;12y buccal administration. Not licensed for Migraine indication in &lt;12y.<\/td><td>&nbsp;<\/td><td>Fatigue, constipation, dry mouth, dizziness.&nbsp;<\/td><\/tr><tr><td>Ondansetron&nbsp;<\/td><td>Off-license use.&nbsp;<\/td><td>Small increased risk of cleft palate if taken in 1<sup>st<\/sup>&nbsp;trimester of pregnancy, may be relevant when prescribing in teenage girls.&nbsp;<\/td><td>Constipation, feeling hot.&nbsp;<\/td><\/tr><tr><td>Propranolol&nbsp;<\/td><td>Licensed.<\/td><td>Increased deaths due to Propranolol overdose. Consider patients mental health before prescribing. Avoid if asthmatic.&nbsp;<\/td><td>Fatigue, bradycardia, dyspnoea, sleep disorders.&nbsp;<\/td><\/tr><tr><td>Pizotifen&nbsp;<\/td><td>Licensed &gt;5 years.&nbsp;<\/td><td>&nbsp;<\/td><td>Fatigue, weight gain, dry mouth.&nbsp;<\/td><\/tr><tr><td>Amitriptyline&nbsp;<\/td><td>Off-license use.<\/td><td>Anticholinergic syndrome, QT prolongation.&nbsp;Caution if weaning\/stopping due to withdrawal.<\/td><td>Dry mouth, constipation, drowsiness.&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">Nutracuticals <\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">There is some limited evidence for the use of riboflavin, vitamin D,&nbsp;magnesium&nbsp;and melatonin.&nbsp;These can be purchased over-the-counter as a suitable low-risk intervention prior to&nbsp;commencing&nbsp;prophylactic medication or&nbsp;used&nbsp;in conjunction. For advice on suggested doses see this link <a href=\"https:\/\/www.texaschildrens.org\/sites\/default\/files\/uploads\/documents\/Neuro_Dietary%20supplements%20sheet.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Neuro_Dietary supplements sheet.pdf<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><strong>Information for primary care professionals:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>NICE guidance on headache red flags <a href=\"https:\/\/www.nice.org.uk\/guidance\/ng127\/chapter\/Recommendations-for-children-aged-under-16#headaches-in-children\" target=\"_blank\" rel=\"noreferrer noopener\">Recommendations for children aged under&nbsp;16 | Suspected neurological conditions: recognition and referral | Guidance | NICE<\/a><\/li>\n\n\n\n<li>NICE management <a href=\"https:\/\/cks.nice.org.uk\/topics\/migraine\/management\/young-people-aged-12-17-years\/\" target=\"_blank\" rel=\"noreferrer noopener\">Scenario: Young people aged 12-17 years | Management | Migraine | CKS | NICE<\/a><\/li>\n\n\n\n<li>Clinical information including red flags <a href=\"https:\/\/mybrainfirst.org\/clinical\/decision-support-tool\/\" target=\"_blank\" rel=\"noreferrer noopener\">HeadSmart &#8211; HeadSmart<\/a><\/li>\n\n\n\n<li>Information for screens <a href=\"https:\/\/healthprofessionalsforsaferscreens.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">Health Professionals for Safer Screens &#8211; Our campaign<\/a>&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Information for families:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Headache information <a href=\"https:\/\/www.headachereliefguide.com\/\" target=\"_blank\" rel=\"noreferrer noopener\">Home | Headache Relief Guide<\/a>&nbsp;, <a href=\"https:\/\/www.gosh.nhs.uk\/conditions-and-treatments\/general-medical-conditions\/headache\/\" target=\"_blank\" rel=\"noreferrer noopener\">Headache | Great Ormond Street Hospital<\/a><\/li>\n\n\n\n<li>Migraine information and headache diary <a href=\"https:\/\/migrainetrust.org\/news\/migraine-and-children\/\" target=\"_blank\" rel=\"noreferrer noopener\">Migraine and children &#8211; The Migraine Trust<\/a><\/li>\n\n\n\n<li>Lifestyle advice, relaxation techniques and headache diary:\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2026\/02\/Tension-headache-information-pack-7-12-year-olds.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Tension Headache Information Pack for 7-12 year olds<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2026\/02\/Tension-headache-information-pack-teenagers.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Tension Headache Information Pack for Teenagers<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2026\/02\/Migraine-information-pack-7-12-year-olds.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Migraine Information Pack for 7-12 year olds<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2026\/02\/Migraine-information-pack-teenagers.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Migraine Information Pack for Teenagers<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Advice for improving sleep <a href=\"https:\/\/sleepaction.org\/learn-about-sleep\/10-tips-for-better-sleep-for-your-child\/\" target=\"_blank\" rel=\"noreferrer noopener\">10 tips to help your child sleep better | Sleep Action<\/a>&nbsp;<\/li>\n\n\n\n<li>Information for families about screens including family digital plans <a href=\"https:\/\/healthprofessionalsforsaferscreens.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">Health Professionals for Safer Screens &#8211; Our campaign<\/a><\/li>\n\n\n\n<li>Mental health resources, NHS Lothian,&nbsp; <a href=\"https:\/\/services.nhslothian.scot\/camhs\/online-resources\/\" target=\"_blank\" rel=\"noreferrer noopener\">Online Resources \u2013 Child and Adolescent Mental Health Services<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Any child presenting with a new or changed headache should be assessed for red or amber flags (listed in the tables below) through history and examination. Examination should include: If indicated from the history, consider also doing a pubertal status, ENT or MSK neck examination. Red Flag Possible Intracranial pathology&nbsp; Referral&nbsp; &bull; Wakes through the<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1396,1176],"class_list":["post-28131","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-headache","category-https-apps-nhslothian-scot-refhelp-medical-paediatrics"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"mariamazoysaavedra","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/mariamazoysaavedra\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/https-apps-nhslothian-scot-refhelp-medical-paediatrics\/https-apps-nhslothian-scot-refhelp-headache\/\" rel=\"tag\">Headache<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/https-apps-nhslothian-scot-refhelp-medical-paediatrics\/\" rel=\"tag\">Medical Paediatrics<\/a>","rttpg_excerpt":"Any child presenting with a new or changed headache should be assessed for red or amber flags (listed in the tables below) through history and examination. Examination should include: If indicated from the history, consider also doing a pubertal status, ENT or MSK neck examination. Red Flag Possible Intracranial pathology&nbsp; Referral&nbsp; &bull; Wakes through the","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28131","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=28131"}],"version-history":[{"count":8,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28131\/revisions"}],"predecessor-version":[{"id":28313,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28131\/revisions\/28313"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=28131"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=28131"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}