1: Peds Headache

Question 1

Doses for abortive treatment of tension headaches:
Acetaminophen \_\_\_\_\_
Ibuprofen \_\_\_\_\_
Naproxen \_\_\_\_\_
Fioricet \_\_\_\_\_
Codeine \_\_\_\_\_
Midrin \_\_\_\_\_

Answer 1

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.

Question 2

T/F Migraines are usually of longer duration in children than adults.

Answer 2

False. Usually of shorter duration that in adults.

Question 3

What are 2 alternative tension headache treatments if OTC don’t work?

Answer 3

Indomethacin PR (not for young children)
Toradol

Question 4

Anyone showing features suggestive of structural cause should undergo high-quality imaging, such as _____.

Answer 4

Anyone showing features suggestive of structural cause should undergo high-quality imaging, such as MRI with gandolinium.

Question 5

Are pediatric migraines unilateral or bilateral?

Answer 5

Often bilateral in children.

Question 6

When should imaging be performed?

Answer 6

Suspect structural etiology

Question 7

What are the preventative treatment options for chronic tension headaches in peds?

Answer 7

Tricyclics
SSRIs (less effective than TCAs)
Gabapentin
Divalproex sodium (Depakote)

Question 8

What are preventative treatments for peds migraines (4)?

Answer 8

Same as adults:
BBs
Tricyclics
Anticonvulsants
CCBs

Question 9

Which med is a sympathomimetic with acetaminophen and chloral hydrate derivative?

Answer 9

Midrin

Question 10

T/F Sleep may stop a migraine.

Answer 10

True

Question 11

_____ imaging is best for acute situations in which time is a factor.

Answer 11

CT imaging is best for acute situations in which time is a factor.

Question 12

In younger children, _____ are common, so no oral meds.

Answer 12

In younger children, n/v are common, so no oral meds.

Question 13

T/F Children can have migraines and tension headaches at the same time.

Answer 13

True

Question 14

If imaging is only for parental reassurance, order _____ or _____.

Answer 14

If imaging is only for parental reassurance, order CT or routine MRI.

Question 15

T/F Interview patients alone as well as with parents b/c children often describe hx more accurately than their parents.

Answer 15

True

Question 16

What are common auras in peds (3)?

Answer 16

Spots/different colors
Image distortions
Visual scotomas

Question 17

These could be seen with secondary headaches (6).

Answer 17

Fever
Sinusitis
Otitis media
Pharyngitis
Mono
Mild head trauma

Question 18

T/F Triptans are approved for migraine abortive treatment in peds.

Answer 18

False. Not FDA approved for under 18, but used in clinical practice effectively and safely.

Question 19

Studies show which meds are the more effective for migraine treatment in peds?

Answer 19

NSAIDs more effective. Naproxen and ibuprofen for severe attacks.

Question 20

What is the most common cause of secondary headaches?

Answer 20

Viral infx

Question 21

Which simple analgesics should be tried first for tension headaches?

Answer 21

ASA (not those at risk for Reye’s syndrome)
Tylenol
NSAIDs
Caffeine

Question 22

T/F Most headaches in children and adolescents are not d/t serious underlying disorders.

Answer 22

True

Question 23

What combination meds can be used in peds for tension headache relief (4)?

Answer 23

Fiorinal
Fioricet
Excedrin migraine
Midrin

Question 24

What are common concerns to cover in headache hx (5)?

Answer 24

School/peer issues
Symptoms of depression
Abuse
Alcohol/drug use
Eating patterns

Question 25

T/F Tension headaches in peds can be episodic or chronic and are very common.

Answer 25

True. They are usually mild and respond to OTC meds.

Question 26

How do you treat migraines in younger children?

Answer 26

Antiemetic suppositories followed by oral meds.

Question 27

70% of peds have a headache by age ____.

Answer 27

70% of peds have a headache by age 15.

Question 28

T/F Combinations of antiemetics, analgesics, and sedatives can be used to help abort a migraine.

Answer 28

True

Question 29

T/F Comprehensive neuro exam should be performed with headaches.

Answer 29

False. If child appears well comprehensive neuro exam is unnecessary.

Question 30

Peds red flags for headaches (15).

Answer 30

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

Question 31

Migraine triggers in peds (8).

Answer 31

``` Stress/anxiety Oral contraceptives Menses Physical exertion/fatigue Lack of sleep Glare Hunger Foods or beverages with nitrates, MSG, caffeine ```

Question 32

T/F Imaging is usually unnecessary with a headache pattern that has remained the same for years.

Answer 32

True. There is a low likelihood of serious intracranial pathology.

Question 33

_____ exam can be difficult with children who struggle to follow directions. If other exam results are normal, less time can be spent on this.

Answer 33

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.

Question 34

Sedatives can be helpful with migraines in peds. What should you start with?

Answer 34

Benadryl. Can also prescribe benzodiazepines.

Question 35

T/F Imitrex is effective in children, even though it is not FDA approved.

Answer 35

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.