My 11 year old daughter has complained recently that she has occasional severe headaches. What would be the normal procedures a doctor would go through to determine the causes, and what specific type of doctor is recommended. Other symtoms include nausea, hot and cold flashes, and body aches.
Answer --------
The cause of headaches in children is often difficult to determine. The story from the patient is the most important "test" in figuring out the cause.
As a family physician, I always try to find out what emotional and social stresses may have started at the same time as the headaches. Muscular tension aggravated by physical or emotional stress is probably the most common cause of headaches.
Migraine headaches are often preceded by a stereotypical feeling, sound, smell, or visual disturbance called an aura. Often nausea and avoidance of bright light accompanies the headache. Often other family members, especially females, will have or have had migraines. Given your daughter's nausea, hot and cold flashes, and body aches, migraines would be a consideration, especially if they recur before each menstrual period.
So rare are tumors as the cause of headaches, that I often skip the physical exam of the neurologic system on the first visit for headaches. Constant headaches worst in the morning and waking the person from sleep are concerning. If tumor is suspected, a CAT scan could detect most of them.
Most general physicians (i.e. family physicians or pediatricians or internists) can diagnose common causes of headaches and prescribe treatment well, since we see so much of it everyday. Neurologists are not needed to help most people with headaches, though if standard treatments don't help and worrisome symptoms occur, then their expertise can be helpful. Osteopathic or chiropractic manipulation for muscle tension can be helpful in the hands of a wise and experienced practitioner. Acupuncture and massage can also help. We "allopathic" physicians (MDs) are generally poorly trained in pain relief except with medications.
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Paul Hunter, M.D.
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