4.1 Headaches

Question 1

Headaches are common in childhood and increase in frequency and incidence in ___

Answer 1

adolescence

Question 2

What is the root cause of the pain associated with headaches

Answer 2

whe pain-sensitive intracranial structures are activated

Question 3

What are primary vs secondary headaches

Answer 3

primary - not caused by any other medical condition

secondary - result from underlying condition or external factor

primary –> tension-type, cluster, migraine type

secondary caused by things like tumor, hydrocephalus, infection, intoxication [lead, carbon monoxide], idiopathic intracranial hypertension, increased intracranial pressure

Question 4

make cards for box 46.2

Question 5

Table 46.3 cards

Question 6

What are three precursor symptoms/conditions that can indicate a predisposition to migraines

Answer 6

cyclic vomiting
abdominal migraine
BPPV

Question 7

FYI - Migraine and migraine with aura: These can be differentiated by the presence or absence of aura symptoms (Table 46.3).
Characteristics of migraines include nausea, abdominal pain, vomiting, unilateral pain, pulsating pain, relief with sleep, an aura, visual changes such as dark or blind spots, and a history of a family member (usually on the maternal side) with migraine without aura. Dizziness and motion sickness may be described.

Question 8

How do toddlers present with headaches

3

Answer 8

• irritable
• sleepiness
• pallor

Question 9

What symptoms are common in preadolescents with migraines

Answer 9

frontal pain
lethargy
sleepy

n/v dont always occur

Question 10

What migraine characteristics are unique to peds

• duration of ___ to ___ hours
• evidence of ___

Answer 10

• duration of 1 to 72 hours
• evidence of pulsating (self-reported with heartbeat)

Question 11

What is characteristic of a tension headache

Answer 11

band squeezing head feeling

can last for days to weeks but don’t interfere with activities usually

Question 12

Where is the pain in tension headaches besides the squeezing band

Answer 12

dull - bifrontal or occipital

no prodrome, n/v rare

In children, it can be difficult to differentiate migraine and tension-type headaches.

Question 13

What medications can result in overuse headaches

Answer 13

NSAIDS
“migraine meds”

Question 14

What pattern of medication use is seen in overuse headaches

Answer 14

med use for 15 days per month with noted gradual increase in headache frequency despite use of analgesic treatment

Question 15

What is an abdominal migraine

Answer 15

midline abdo pain with n/v with minimal or no headache

This rare and somewhat controversial diagnosis
can be suggestive of complex partial seizures and may merit further evaluation.

Question 16

box 46.3
box 46.4

Question 17

Is imaging routinely done for headaches

Answer 17

no- unless sudden onset, increased severity, change in pattern

Neuroimaging must be considered in children whose headaches do not meet specific criteria for a primary headaches syndrome, or who have an abnormal physical examination

Question 18

If imaging for headaches is needed what is first line imaging

Answer 18

MRI

Question 19

What is the first line treatment for acute headaches

Answer 19

NSAIDS

Question 20

Table 46.4
46.5
46.6

Question 21

When should abortive medications like triptans be taken

Answer 21

as soon as headache starts

Question 22

When should prophylactic therapy be considered

Answer 22

when migraines are causing kid to miss school regularly or getting severemigraines 2-4x per month

Question 23

What complementary therapies can be used for migraines

Answer 23

accupuncture/pressure
nerve blacks
osteopath
yoga
PT
massage

Question 24

When should patients be referred off for headaches

2

Answer 24

• suspected structural cause
• persisting chronic headaches

Question 25

What should the management plan for headaches in kids include besides meds

3

Answer 25

dark room
rest
ice