described by the patient or parents (see Chapter 97 Neurologic Emergencies ) Often, a strong family history of migraines is present For the emergency physician, the main issue with migraine patients is generally pain control, because the diagnosis is already known However, a significant change in the quality, severity, or timing of headaches in these patients may represent a separate and potentially more serious problem In such cases, the clinician should not be dissuaded by the existing diagnosis from pursuing an appropriate workup as indicated Headaches accompanying fever are also believed to be mediated by vascular effects Because fever is such a common symptom, this is probably the most common cause of headaches in pediatric patients seen in the ED Hypertension, although rare, is another possible cause of vascular headaches in children Renovascular disease leading to hypertension can in some instances be a lifethreatening etiology Additionally, children and teenagers may have an undiagnosed coarctation of the aorta leading to hypertension and associated headaches Because of its rarity, this condition is easily misdiagnosed Hypertension causes not only global changes in cerebral vasculature, but also possibly a component of increased intracranial pressure (ICP) that leads to headache