Headache Flashcards
List the prevalence of migraines in children
1 - 3 % in kids 3 - 7 years
8 - 23 % in adolescents
Males more in childhood
Females more after puberty
List the criteria for pediatric migraine WITHOUT aura
A. At least 5 attacks fulfilling criteria b-d
B. Duration of 1-72h (untreated or unsuccessfully treated)
C. Headache has at least 2 of the following:
- bilateral (frontal/temporal) or unilateral location
- pulsatile quality
- moderate or severe intensity
- aggravation by or causing avoidance of routine physical activity
D. During the headache at least one of the following occurs:
- Nausea and/or vomiting
- Photophobia and/or phonophobia (which may be inferred from behaviour)
E. Not attributed to another disorder
List the criteria for pediatric migraine WITH aura
A. At least 2 attacks fulfilling criteria b-d
B. At least one of the following:
- Fully reversible visual symptoms including positive features (ex. flickering lights, spots or lines) and/or negative features (ex. loss of vision)
- Fully reversible sensory problems including positive features (ex. parasthesias) and/or negative features (ex. numbness)
C. At least two of the following:
- Homonymous visual symptoms and/or unilateral sensory symptoms
- At least one aura symptom that develops gradually over 5 minutes or longer and/or different aura symptoms occur in succession over 5 minutes or longer
- Each symptom lasts 5 minutes or longer and less than 60 minutes
D. Headache criteria fulfilling B-D for migraine that begins during aura or follows aura within 60 minutes
E. Not attributed to another disorder
List some triggers for migraine in children
Stress
Lack of sleep
Changes in normal eating patterns
Weather changes
Medications - asthma treatment and stimulants
Foods (caffeine, nitrates, tyramine, glutamate, salt)
Less common
Eye strain, cold foods, high altitude
List the prevalence of tension headaches in children
10-25%
What are the 3 subtypes for tension headaches
1) Infrequent episodic (< 1 day/month)
2) Frequent episodic (1-14 days/month)
3) Chronic (> 15 days/month)
What characteristics do tension headaches have?
Mild- mod pressing pain (or tightening) Nonpulsatile Lasts 4-6 hours Bilateral Not aggravated by routine activity No N/V Photo/phonophobia may be present
What are risk factors for tension headaches
Anxiety
Stressors - family or school
What features of a headache make you concerned with a brain tumor?
Location - occipital or headaches located at the nape of the neck
Timing - awaken the child from sleep or that are worse in the AM and improve on rising
Positioning - worsen with body movement, especially bending forward, and improve with change in position
Change over time - headaches that change in frequency, severity, or other characteristics
Worsening with sneezing, coughing, straining
Headaches associated with blurred vision
Headaches associated with neurologic signs or symptoms
History of a syndrome associated with tumors (Neurofibromatosis, Tuberous sclerosis)
What is the prevalence of Chronic Daily Headaches (CDH) in kids
1 - 6%
More in females, psychiatric comorbid conditions
What are the most important PEx features in assessment of kids with headache
Vitals - HR, BP
Weight, height, HC
Neuro exam - CN, gait, strength, coordination, DTR, speech
Fundoscopic exam
Signs of trauma
Skin exam for neurocutaneous syndromes - cafe au lait spots - ? NF and ? tumor
Indications for neuroimaging
- Headache associated with abnormal neurologic findings (especially papilledema, mental status changes, gait or motor disturbances)
- Seizures
- Persistent headaches not associated with family history of migraines
- Headaches that awaken the child from sleep, present on awakening
- Persistent headache associated with episodes of confusion, disorientation, or vomiting
- New severe headache or worsening of a previously stable headache
- FHx or PMHx of disorders predisposing one to CNS lesions (NF, TS, Down’s)
- Clinical or lab findings suggestive of CNS involvement
What are the management recommendations for kids with acute headache?
IVF
NSAIDS
Tylenol
Sometimes PO/IN triptans
Anti-emetics - prochlorperazine, metoclopramide, zofran - helpful adjuncts - can cause dystonic reactions
- can resolve with benadryl
Avoid narcotics - rebound headaches
Prophylactic meds should be started with the consultation of a neurologist - include TCAs, cyproheptadine, anti-hypertensives, antiepileptics
What lifestyle changes can be made for prevention of headaches?
Adequate sleep
Avoiding the use of electronics in the bedroom at night
Regular bedtime schedule
Routine exercise
Eating a well-balanced diet - healthy meals and eating breakfast
Adequate hydration
Limit caffeine
Identifying, avoiding and managing triggers
What treatments are available for tension headaches
Diaries to identify and manage/avoid triggers Analgesics Amitriptyline Biofeedback Relaxation techniques Cognitive behavioural therapy
