Headaches are one of the most common outpatient and acute paediatric presentations – most are thankfully benign, but how do you make sure you don’t miss something more sinister?

HeadSmart is a charity dedicated to raising awareness of symptoms of brain tumours in children – these TOP TEN TIPS go further than the normal ‘red flags’ we all know. The following tips are adapted from their guide for clinicians which is endorsed by the RCPCH.

1. 450 children in the UK are diagnosed with a brain tumour each year. Brain tumours are the most common cause of cancer-related death, and 60% of survivors have a life altering disability.

2. Symptoms that fluctuate (i.e. resolve then recur) do NOT exclude a brain tumour.

3. Consider a brain tumour in children who present with any combination of growth failure, disordered puberty and polyuria/polydipsia

4. Full assessment of vision is essential – if the child is uncooperative or too young for you to do this reliably, refer them urgently to an ophthalmologist

5. Always measure and plot head circumference in children under 2 years with any neurological concerns, or persistent vomiting

6. A child with migraines could still have a brain tumour – don’t dismiss their symptoms if the character of the headache changes

7. Think about the possibility of a brain tumour in persistent nausea and vomiting – especially children with ‘reflux’ if failing to thrive and unresponsive to medication

8. Lethargy is the most common behavioural change that occurs with a brain tumour.

9. Torticollis which does not resolve within 2-4 weeks could be a sign of a posterior fossa tumour – make sure any child presenting with torticollis has appropriate follow up

10. Bear in mind that the symptoms aren’t always obviously neurological – for example a child with recurrent chest infections could in fact have a bulbar palsy and chest infections due to aspiration.