Ch 14 - Peds/Headache Flashcards
Major features of migraine
PUNT
Photo/phonophobia
Unilateral
Nausea
Throbbing
Diagnostic Criteria for migraine w/o aura
A. At least 5 headaches >4-72 hours in adults and 1-72 hours in children
with at least 2/4 features:
- Unilateral
- Throbbing
- Moderate/Severe
- Aggravation or avoidance of daily routine.
PLUS
B. During each headache, at least 1/2 must occur
- Photo AND phonophobia
- Nausea or vomiting.
Diagnostic criteria of migraine w/ aura
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
Abdominal migraine?
intermittent attacks of abdominal pain, vomiting and anorexia.
Acute confusional migraine?
Typically in children >5 yo, pain + disorientation/agitation that lasts for a few hours and resolves on its own.
Alice in Wonderland Syndrome?
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)
Benign paroxysmal vertigo
intermittent episodes of unsteadiness that may be accompanied by nystagmus or vomiting.
Basilar Artery Migraine aka Bickerstaff’s syndrome
vertigo + ataxia + dysarthria + tinnitus + vision changes
typically an occipital headache
What is unique about the treatment of basilar artery migraine/Bickerstaff syndrome?
Triptans are contraindicated (and other vasoconstrictors)
Cyclic vomiting
intermittent episodes of vomiting that can lead to dehyration
Hemiplegic Migraine
type of migraine w/ aura
transient hemiparesis followed by a headache.
Familial Hemiplegic migraine type 1 - mutation
mutation in CACNA1A gene on chromosome 19p
also assoc with spinocerebellar ataxia and episodic ataxia
Familial Hemiplegic migraine type 2
mutation in ATP1A12 gene on 1q
associated with alternating hemiplegias of childhood.
Familial Hemiplegic migraine type 3
mutation in the SCN1A gene
also assoc with generalized epilepsy with febrile seizures plus and Dravet Syndrome
Menstrual Migraine (Catamenial Migraine) - typically with or without aura?
without!
aura is unrelated to the menstrual cycle
PURE Menstrual Migraine without aura - dx criteria
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.
Menstrually related migraine w/o aura - dx criteria
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.
Treatment for menstrual migraines
hormone therapy
It is believed that menstrual migraines are due to estrogen or progesterone withdrawal.
Ophthalmoplegic migraine
ophthalmoplegia and orbital pain sometimes with ptosis or a dilated pupil.
MRI may show thickening of CN3
Paroxysmal Torticollis
episodes of head tilt, vomiting and ataxia that lasts for hours to days.
Retinal migraine/Ophthalmic migraine
positive or negative visual phenomenons in assoc with a headache
Concussion vs contusion
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.
