Background Headache is a very common complaint in children presentating to the Paediatric Emergency Department (PED) and causes concern in parents and physicians regarding malignant intracranial processes. Aim of this study is to search for malignant etiologies in children presenting to the PED with headache as primary complaint.

Patients and methods All digital medical charts of children < 16 years presenting to the PED between August 2011 and August 2013 with headache as primary complaint were retrospectively reviewed. Children with history of intracranial tumorsor surgery, recurrent headache under investigation or treatment, or traumatic headache were excluded. Age, gender, brain imaging and final diagnoses were registered.

Results Of all 34,336 children seen at the PED during 2 years, 117 (0.3%) consulted with headache as primary complaint: 61 boys (8.4 years ± 3.4) and 56 girls (8.6 years ± 3.7). Brain imaging (CT or MRI) was performed in 33/117 children (28%) because of clinical suspicion of intracranial processes: presence of associated neurological symptoms, valsalva manoeuvre increasing pain intensity, evolution with intensifying pain, recurrent focal pain, change in pattern/intensity, lack of response to analgesics and aberrant neurological features. Most frequent medical conclusions were “headache related to a viral infection”, “migraine”, “tension type headache”, “psychosomatic headache” and “headache without identified origin”. None of these patients suffered from a brain tumour.

Conclusions Children presenting to the PED with headache as primary complaint are not likely to suffer from a malignant brain tumour. More frequent their headache is related to a concurrent viral infection.