Ch 14 - Peds/Headache

Question 1

Major features of migraine

Answer 1

PUNT
Photo/phonophobia

Unilateral

Nausea

Throbbing

Question 2

Diagnostic Criteria for migraine w/o aura

Answer 2

A. At least 5 headaches >4-72 hours in adults and 1-72 hours in children

with at least 2/4 features:

1. Unilateral
2. Throbbing
3. Moderate/Severe
4. Aggravation or avoidance of daily routine.

PLUS
B. During each headache, at least 1/2 must occur

1. Photo AND phonophobia
2. Nausea or vomiting.

Question 3

Diagnostic criteria of migraine w/ aura

Answer 3

A. One of the following aura features

• Language difficulty
• unilateral paresthesias/anesthesia
• unilateral weakness
• homonymous vision disturbance

B. At least 2 headaches with at least 3/4 items

• 1 fully reversible aura
• aura >4 mins
• Aura < 60 mins (unless multiple auras arise)
• Migraine FOLLOWS aura

Question 4

Abdominal migraine?

Answer 4

intermittent attacks of abdominal pain, vomiting and anorexia.

Question 5

Acute confusional migraine?

Answer 5

Typically in children >5 yo, pain + disorientation/agitation that lasts for a few hours and resolves on its own.

Question 6

Alice in Wonderland Syndrome?

Answer 6

spatial distortion and illusions before a migraine

(ex: objects appear smaller or larger, time passes very slowly, movement seems very slow and velocity is misperceived)

Question 7

Benign paroxysmal vertigo

Answer 7

intermittent episodes of unsteadiness that may be accompanied by nystagmus or vomiting.

Question 8

Basilar Artery Migraine aka Bickerstaff’s syndrome

Answer 8

vertigo + ataxia + dysarthria + tinnitus + vision changes

typically an occipital headache

Question 9

What is unique about the treatment of basilar artery migraine/Bickerstaff syndrome?

Answer 9

Triptans are contraindicated (and other vasoconstrictors)

Question 10

Cyclic vomiting

Answer 10

intermittent episodes of vomiting that can lead to dehyration

Question 11

Hemiplegic Migraine

Answer 11

type of migraine w/ aura

transient hemiparesis followed by a headache.

Question 12

Familial Hemiplegic migraine type 1 - mutation

Answer 12

mutation in CACNA1A gene on chromosome 19p

also assoc with spinocerebellar ataxia and episodic ataxia

Question 13

Familial Hemiplegic migraine type 2

Answer 13

mutation in ATP1A12 gene on 1q

associated with alternating hemiplegias of childhood.

Question 14

Familial Hemiplegic migraine type 3

Answer 14

mutation in the SCN1A gene

also assoc with generalized epilepsy with febrile seizures plus and Dravet Syndrome

Question 15

Menstrual Migraine (Catamenial Migraine) - typically with or without aura?

Answer 15

without!

aura is unrelated to the menstrual cycle

Question 16

PURE Menstrual Migraine without aura - dx criteria

Answer 16

A. attacks in a menstruating women fitting migraine w/o aura criteria

B. attacks that occur at least -2 - +3 days of menstruation in at least 2 of every 3 cycles and at no other times of the cycle.

Question 17

Menstrually related migraine w/o aura - dx criteria

Answer 17

A. attacks in a menstruating women fitting migraine w/o aura criteria

B. attacks that occur at least -2 - +3 days of menstruation in at least 2 of every 3 cycles and additionally at other times during the cycle.

Question 18

Treatment for menstrual migraines

Answer 18

hormone therapy

It is believed that menstrual migraines are due to estrogen or progesterone withdrawal.

Question 19

Ophthalmoplegic migraine

Answer 19

ophthalmoplegia and orbital pain sometimes with ptosis or a dilated pupil.

MRI may show thickening of CN3

Question 20

Paroxysmal Torticollis

Answer 20

episodes of head tilt, vomiting and ataxia that lasts for hours to days.

Question 21

Retinal migraine/Ophthalmic migraine

Answer 21

positive or negative visual phenomenons in assoc with a headache

Question 22

Concussion vs contusion

Answer 22

Concussion - acute confusion or LOC after TBI often with dec reflexes, paralysis, bradycardia. Imaging is typically NORMAL

Contusion - brain tissue bruise after TBI resulting in microhemorrhages or even SDH.