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Paediatrics 4MB > Headache > Flashcards

Headache Flashcards

1
Q

List the 3 different classifications of headache

A
  1. Primary headache
  2. Secondary headache
  3. Trigeminal and other cranial neuralgias and other headaches
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2
Q

Define a primary headache

A

Four main groups of headaches thought to be due to a primary malfunction of neurons and their networks

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3
Q

Define a secondary headache

A

A headache that is symptomatic of some underlying pathology

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4
Q

List the causes of primary headaches

A
  1. Migraine
  2. Tension-type headache
  3. Cluster headache and other trigeminal autonomic cephalagias
  4. Other primary headaches (e.g. primary stabbing headache)
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5
Q

List the causes of secondary headaches

A
  1. Medication overuse
  2. Head and/or neck trauma
  3. Cranial or cervical vascular disorder - vascular malformation or intracranial haemorrhage
  4. Non-vascular intracranial disorder - raised ICP, idiopathic intracranial hypertension
  5. A substance or its withdrawal
  6. Infection - meningitis, encephalitis, abscess
  7. Disorder of homeostasis - hypercapnia or HTN
  8. Disorder of facial or cranial structures - acute sinusitis
  9. Associated with emotional disorders
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6
Q

Define a tension type headache

A

Symmetrical headache of gradual onset, often described as tightness, a band or pressure.
Usually no other symptoms.

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7
Q

List the different types of migraine

A
  1. Migraine with aura
  2. Migraine without aura
  3. Uncommon types of migraine
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8
Q

What are the characteristics of migraine without aura?

A
  1. Episodes may last 1-72hrs
  2. Commonly bilateral (but may be unilateral)
  3. Pulsatile
  4. Temporal or frontal area
  5. Often associated with unpleasant GI disturbance
  6. Associated with photophobia and phonophobia
  7. Aggravated by physical activity
  8. Relieved by sleep
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9
Q

What are the characteristics of migraine with aura?

A
  1. Headache is preceded by an aura (visual, sensory or motor)
  2. Aura may occur without headache
  3. Absence of problems between episodes
  4. Frequent presence of premonitory symptoms (tiredness, difficulty concentrating, autonomic features)
  5. Attacks usually last for a few hours
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10
Q

Discuss the types of visual aura associated with migraine

A
  1. Negative phenomena - hemianopia, scotoma (small areas of visual loss)
  2. Positive phenomena - fortification spectra (seeing zig-zag lines)
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11
Q

List the uncommon types of migraine

A
  1. Familial hemiplegic migraine
  2. Sporadic hemiplegic migraine
  3. Basilar-type migraine
  4. Periodic syndromes
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12
Q

What are the different periodic syndromes that can be present?

A
  1. Cyclical vomiting
  2. Abdominal migraine
  3. Benign paroxysmal vertigo of childhood
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13
Q

What are the features of cyclical vomiting?

A
  1. Recurrent stereotyped episodes of vomiting and intense nausea
  2. Associated with pallor and lethargy
  3. Well in between episodes
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14
Q

What are the features of abdominal migraine?

A
  1. Episodic midline abdominal pain
  2. Recurrent, bouts last 1-72hrs
  3. Pain is moderate to severe in intensity
  4. Associated with vasomotor symptoms, nausea and vomiting
  5. Well between episodes
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15
Q

What are the features of benign paroxysmal vertigo of childhood?

A
  1. Recurrent brief episodes of vertigo
  2. Occur without warning and resolve spontaneously
  3. Otherwise healthy children
  4. Between episodes neurological exam, audiometric and vestibular function tests are normal
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16
Q

List the red flag symptoms for space occupying lesion in a child presenting with headache

A
  1. Headache worse lying down or with coughing and straining
  2. Headache wakes child up
  3. Associated confusion, and/or morning or persistent nausea or vomiting
  4. Recent change in personality, behaviour or educational performance
17
Q

List the red flag physical signs for space occupying lesion in a child presenting with headache

A
  1. Growth failure
  2. Visual field defects (craniopharyngioma)
  3. Squint
  4. Cranial nerve abnormality
  5. Torticollis
  6. Abnormal coordination (cerebellar lesions)
  7. Gait (upper motor neurone or cerebellar signs)
  8. Papilloedema
  9. Bradycardia
  10. Cranial bruits (arteriovenous malformations)
18
Q

What would you ask about in the history of a child presenting with headache?

A
  1. Premonitory symptoms
  2. Aura
  3. Character
  4. Position
  5. Radiation
  6. Frequency
  7. Duration
  8. Triggers
  9. Relieving and exacerbating factors
19
Q

What other things should be considered when asking about headache?

A
  1. Triggers - stress, relaxation, food, menstruation
  2. Emotional or behavioural problems
  3. Vision checked (refractive error)
  4. Head trauma
  5. Alcohol, solvent or drug abuse
  6. Analgesia over-use
20
Q

What are the characteristics of medication overuse headaches?

A
  1. Patient with primary headache develops rebound chronic daily headache (headache on 15 or more days of the month)
  2. Use acute analgesics or triptans on more than 2 days a week
  3. Withdrawing offending medication resolves this in 2wks
21
Q

How can we manage headache?

A
  1. Mainstay is Hx and exam
  2. Make a specific headache diagnosis
  3. Written, child friendly information
  4. Advise children on how to live with and control the headaches
  5. Rescue treatments
  6. Prophylactic treatments
  7. Psychosocial support
22
Q

What rescue treatments can be used in the management of headache?

A
  1. Analgesia - Paracetamol and NSAIDs; take ASAP
  2. Antiemetics - prochlorperazine or cyclizine
  3. Triptans - serotonin agonists (sumatriptan)
  4. Physical treatments - cold compresses, warm pads, topical forehead balms
23
Q

What prophylactic treatments can be used in the management of headache?

A
  1. Sodium channel blockers (topiramate or valproate)
  2. Beta-blockers (propranolol)
  3. Tricyclics (pizotifen - can cause weight gain and sleepiness; amitriptyline - can cause dangerous arrhythmias in overdose
  4. Acupuncture
24
Q

What kinds of psychosocial supports can be used in the management of headache?

A
  1. Psychological support (to help with particular stressors)

2. Relaxation and other self-regulating techniques, addressing lifestyle issues

25
Q

What are the characteristic features of a tension headache?

A
  1. Regular
  2. Often frontal
  3. Not associated with vomiting, paraesthesia, visual disturbance or abnormality on examination
26
Q

When is a tension headache defined as chronic?

A

If present for more than 6wks

27
Q

How is tension headache managed?

A
  1. Reassurance
  2. Suggest analgesia if needed but unlikely to make much difference
  3. Encourage child to partake in normal activities as much as possible
28
Q

List the indicators of raised ICP

A
  1. Abnormal examination:
    - Heel-toe walking
    - Finger-nose coordination
    - Eye movements
    - Fundi (papilloedema)
  2. Severe short history:
    - Vomiting
    - Morning headache
    - Visual disturbance
29
Q

List the secondary causes of intracranial hypertension

A
  1. Drugs:
    - Steroid withdrawal
    - Vitamin A
    - Thyroid replacement
    - OCP
    - Phenothiazines
  2. Systemic disease:
    - Iron deficiency
    - Guillain Barré syndrome
    - SLE
  3. Endocrine changes:
    - Adrenal failure
    - Hyperthyroidism
    - Hypoparathyroidism
    - Menarche
    - Pregnancy
    - Obesity
  4. Head injury
30
Q

How does raised ICP present?

A
  1. Early morning headache
  2. Blurred or double vision
  3. Vomiting
31
Q

What signs will be present on clinical examination and investigations for idiopathic intracranial hypertension (IIH)?

A

Neuro - There may be ataxia
Eyes - Papilloedema; scotoma on visual field testing
Imaging - normal
LP - raised ICP (>20cm CSF); normal CSF cell count, protein and glucose

32
Q

How is IIH managed?

A
  1. Weight loss in obese pts
  2. Remove causal medication (if cause)
  3. Diuretics - reduce CSF formation
  4. Steroids - can cause rebound problems when withdrawn
  5. Serial LP or surgery
  6. Monitoring of eyes and visual fields
33
Q

List the diagnostic criteria for paediatric migraine without aura

A 
A. At least 5 attacks fulfilling B-D
B. Headache attack lasting 1-48hr
C. Headache has at least two of:
 - Bilateral or unilateral location
 - Pulsating quality
 - Moderate to severe intensity
 - Aggravation by routine physical activity
D. During headache, at least one of:
 - Nausea and/or vomiting
 - Photophobia and/or phonophobia
34
Q

List the diagnostic criteria for paediatric migraine with aura

A

A. Idiopathic recurring disorder: headache that usually lasts 1-48hr
B. At least two attacks fulfilling C
C. At least 3 of the following:
- One or more fully reversible aura symptoms indicating focal cortical and/or brainstem dysfunction
- At least one aura developing gradually over >4mins, or two or more symptoms occurring in succession
- No aura lasting >60mins
- Headache follows in <60mins

Paediatrics 4MB (22 decks)

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