19.1. Paediatric Neurology - Headaches

Question 1

What are the Different Pathological Causes of Paediatric Neurological Disease?

Answer 1

1. Congenital Anomalies
2. Neurogenetic Diseases / Syndromes
3. Neurometabolic Diseases / Syndromes
4. Acquired - Infection / Ischaemia / Trauma / Tumour

Question 2

What are the Categories of Developmental History Discussed?

Answer 2

1. Motor Milestones - Gross and Fine Motor Skills
2. Speech and Language Development
3. Early Cognitive Development
4. Play - Symbolic Play / Early Development
5. Self-Help Skills
6. Vision and Hearing Assessment

Question 3

What is looked at in a Paediatric Neurological Examination?

Answer 3

1. Appearance
2. Gait
3. Head Size
4. Skin Findings
5. Real World Examination - Age Dependent
   Note - Opportunistic Approach

Question 4

What are the Common Paediatric Neurological Diseases?

Answer 4

1. Headahce Disorder -
 Migraine
2. Traumatic Brain Injury
3. Tourette Syndrome
4. Epilepsy
5. Brain Tumours

Question 5

How are Headache Disorders Clinically Evaluated?

Answer 5

1. Isolated Acute
2. Recurrent Acute
3. Chronic Progressive
4. Chronic Non-Progressive

Question 6

What is asked about in a Recurrent / Chronic Headache History?

Answer 6

1. Any Warning?
2. Location?
3. Severity?
4. Duration?
5. Frequency?

Question 7

How is a Headache Examined?

Answer 7

1. Growth Parameters - OFC / BP
2. Sinuses / Teeth / Visual Accuity
3. Fundoscopy
4. Visual Fields
5. Cranial Bruit
6. Focal Neurological Signs
7. Cognitive / Emotional Status

Question 8

What are the Indications to Childhood Migraine?

Answer 8

1. Associated Abdominal Pain / Nausea / Vomiting
2. Focal Symptoms / Signs - Before / During / After = Visual Disturbance / Paresthesia / Weakness
3. Pallor
4. Aggravated by Bright Light / Noise
5. Relation to Fatigue / Stress
6. Helped by Sleep / Rest / Dark, Quiet Room

Question 9

What is the Difference between a:

1. Migraine?
2. Tension Headache?

Answer 9

1. a) Hemicranial, Throbbing (Pulsitile) Pain
2. b) Abdominal Pain / Nausea / Vomiting
3. c) Photo/Phonophobia - Relieved by Rest
4. d) Visual / Sensory / Motor Aura
5. a) Diffuse, Symmetrical, Band-Like Distribution of Pain
6. b) Present most of the Time (Constant Ache) but there may be Symptom Free Periods

Question 10

What are the Indications of Raised Intracranial Pressure Headache?

Answer 10

1. Aggravated by Activities which Raise ICP - Coughing / Straining at Stool / Bending
2. Woken from Sleep With Headache

Question 11

What are the Indications of Analgesic Overuse Headache?

Answer 11

1. Headache is Back before allows to use another Dose
2. Paracetamol / NSAID’s
3. Particular Problem with Compound Analgesics - e.g. Cocodamol

Question 12

What are the Indications for Neuroimaging?

Answer 12

1. Features of Cerebellar Dysfunction
2. Features of Raised Intracranial Pressure
3. New Focal Neurological Deficit
4. Seizure - Especially Focal
5. Personality Change
6. Unexplained Deterioration of School Work

Question 13

What is the Management of a Migraine?

Answer 13

1. Acute Attack - Effective Pain Relief = Triptans
2. Preventative:
3. a) Pizotifen
4. b) Propranolol (Beta Blocker)
5. c) Amitryptyline (Tricyclic Antidepressant)
6. d) Topiramate (Anticonvulsant)
7. e) Valproate (Anticonvulsant)

Question 14

What is the Management of a Tension-Type Headache?

Answer 14

1. Aim at Reassurance - No Sinister Cause
2. Attention to Underlying Chronic Physical / Psychosocial / Emotional Problems
3. Acute Attack - Simple Analgesia
   Note - Discourage Analgesics in Chronic Tension-Type Headache