1: Peds Headache Flashcards
Doses for abortive treatment of tension headaches: Acetaminophen \_\_\_\_\_ Ibuprofen \_\_\_\_\_ Naproxen \_\_\_\_\_ Fioricet \_\_\_\_\_ Codeine \_\_\_\_\_ Midrin \_\_\_\_\_
Acetaminophen 10-15 mg/kg q 4H
Ibuprofen 5-10 mg/kg QID
Naproxen 10-20 mg/kg BID
Fioricet 1 tab q 3-4 h. Max 3 a day or 6/week in teenagers.
Codeine 0.5-1 mg/kg q 4-6h
Midrin 1-2 caps at onset, then 1 q 4h. Max 2/day or 6/week. Only in teens.
T/F Migraines are usually of longer duration in children than adults.
False. Usually of shorter duration that in adults.
What are 2 alternative tension headache treatments if OTC don’t work?
Indomethacin PR (not for young children) Toradol
Anyone showing features suggestive of structural cause should undergo high-quality imaging, such as _____.
Anyone showing features suggestive of structural cause should undergo high-quality imaging, such as MRI with gandolinium.
Are pediatric migraines unilateral or bilateral?
Often bilateral in children.
When should imaging be performed?
Suspect structural etiology
What are the preventative treatment options for chronic tension headaches in peds?
Tricyclics
SSRIs (less effective than TCAs)
Gabapentin
Divalproex sodium (Depakote)
What are preventative treatments for peds migraines (4)?
Same as adults: BBs Tricyclics Anticonvulsants CCBs
Which med is a sympathomimetic with acetaminophen and chloral hydrate derivative?
Midrin
T/F Sleep may stop a migraine.
True
_____ imaging is best for acute situations in which time is a factor.
CT imaging is best for acute situations in which time is a factor.
In younger children, _____ are common, so no oral meds.
In younger children, n/v are common, so no oral meds.
T/F Children can have migraines and tension headaches at the same time.
True
If imaging is only for parental reassurance, order _____ or _____.
If imaging is only for parental reassurance, order CT or routine MRI.
T/F Interview patients alone as well as with parents b/c children often describe hx more accurately than their parents.
True
What are common auras in peds (3)?
Spots/different colors
Image distortions
Visual scotomas
These could be seen with secondary headaches (6).
Fever Sinusitis Otitis media Pharyngitis Mono Mild head trauma
T/F Triptans are approved for migraine abortive treatment in peds.
False. Not FDA approved for under 18, but used in clinical practice effectively and safely.
Studies show which meds are the more effective for migraine treatment in peds?
NSAIDs more effective. Naproxen and ibuprofen for severe attacks.
What is the most common cause of secondary headaches?
Viral infx
Which simple analgesics should be tried first for tension headaches?
ASA (not those at risk for Reye’s syndrome)
Tylenol
NSAIDs
Caffeine
T/F Most headaches in children and adolescents are not d/t serious underlying disorders.
True
What combination meds can be used in peds for tension headache relief (4)?
Fiorinal
Fioricet
Excedrin migraine
Midrin
What are common concerns to cover in headache hx (5)?
School/peer issues Symptoms of depression Abuse Alcohol/drug use Eating patterns
T/F Tension headaches in peds can be episodic or chronic and are very common.
True. They are usually mild and respond to OTC meds.
How do you treat migraines in younger children?
Antiemetic suppositories followed by oral meds.
70% of peds have a headache by age ____.
70% of peds have a headache by age 15.
T/F Combinations of antiemetics, analgesics, and sedatives can be used to help abort a migraine.
True
T/F Comprehensive neuro exam should be performed with headaches.
False. If child appears well comprehensive neuro exam is unnecessary.
Peds red flags for headaches (15).
Patient under age of 5
New onset headache
Focal neurological signs
Nocturnal awakening
Headache on awakening
Vomiting
Loss of cognitive/neurological function
Significant change in existing headache pattern
Progressive symptoms, especially with rapid change
Papilledema
Head trauma with loss of consciousness longer than 10 minutes
Inability to control headache with appropriate treatment
Emergence of significant psychosocial problems
Increased difficulty waking child in the morning
Severe, acute headache with alteration in level of consciousness, vomiting, or focal symptoms
Migraine triggers in peds (8).
Stress/anxiety Oral contraceptives Menses Physical exertion/fatigue Lack of sleep Glare Hunger Foods or beverages with nitrates, MSG, caffeine
T/F Imaging is usually unnecessary with a headache pattern that has remained the same for years.
True. There is a low likelihood of serious intracranial pathology.
_____ exam can be difficult with children who struggle to follow directions. If other exam results are normal, less time can be spent on this.
Sensory exam can be difficult with children who struggle to follow directions. If other exam results are normal, less time can be spent on this.
Sedatives can be helpful with migraines in peds. What should you start with?
Benadryl. Can also prescribe benzodiazepines.
T/F Imitrex is effective in children, even though it is not FDA approved.
False. Trials showed oral sumatriptan ineffective in children ages 12-17. Sub Q injection effective, but not recommended below age 18. If using, doses over the age of 12 are 25-50 mg PO, 0.1 mg/kg SQ, or 5 mg nasal spray.
