Which symptom should prompt concern when assessing a child with a headache?

A recent fever in a child with a headache is particularly concerning as it can indicate an underlying infection or serious condition, such as meningitis or encephalitis. In pediatric patients, a headache accompanied by fever raises the suspicion of central nervous system involvement, which requires prompt evaluation and management. These conditions can be life-threatening and manifest with symptoms such as a significant headache, fever, neck stiffness, or altered mental status.

Normal eye movement, prominent sweating, and a history of migraines, while relevant to the overall clinical picture, do not typically indicate an immediate cause for alarm in the same way that a fever does. Normal eye movement suggests that there are no acute neurological deficits, while prominent sweating may be a symptom of anxiety or other less urgent issues. A history of migraines is common in children and does not necessarily signal a new or dangerous condition unless other concerning symptoms are present.