Headache Flashcards
What are the three main groups of headaches in children?
Tension, migraine, and organic.
What is the most common type of headache in children?
Tension, followed by migraine.
List 5 serious causes of headache.
Infection, tumor, intracranial hemorrhage, CO poisoning, and hypertensive encephalopathy.
What is the typical pattern of symptoms seen in patients with tension headaches?
The headaches are infrequent in the morning hours and typically become more severe as the day progresses. They present as a pressing, dull, persistent tightness, often described as a band around the head.
What are three general causes of organic headaches?
Structural abnormalities, metabolic diseases, and infectious etiologies.
What is the preferred imaging modality for patients suspected of having an organic headache?
MRI is the preferred imaging modality, but CT may be used if MRI is unavailable.
What medications are associated with the development of pseudotumor cerebri in adolescents?
Doxycycline, tetracycline, and vitamin A (when it causes hypervitaminosis, such as in patients using retinoic acid for treatment of acne).
What condition should be considered in an adolescent taking doxycycline or tetracycline for treatment of their acne who then presents with new headaches?
Pseudotumor cerebri
List 15 warning signs of organic headaches.
Nocturnal awakening from headache; absence of family history of migraine; vomiting (especially early morning/upon arising); papilledema; confusion; abnormal neuro exam; growth abnormalities; nuchal rigidity; headache worsened by cough, micturition, or defecation; recurrent, localized headache; persistent vomiting; progressive increase in headache frequency or severity; lethargy; personality change; pulsatile tinnitus.
Describe the typical presentation of cluster headaches.
The pain is strictly unilateral, severe, and is supraorbital, retroorbital, or temporal in location. It peaks quickly (within 5-10 minutes) and resolves in 1-2 hours. Patients may have associated ipsilateral autonomic symptoms (ptosis, miosis, lacrimation, eye redness, rhinorrhea, or congestion).
Describe the age and gender distribution of cluster headaches.
Cluster headaches are rare in children < 10 years of age, but become increasingly common between 10 and 20 years of age. Boys are affected much more commonly than girls (3:1 to 4:1).
What is the best treatment for acute symptoms of cluster headaches?
Oxygen. Ihalation of oxygen at 6L/min for 15 minutes is usually rapidly abortive.
What is the drug of choice for prophylaxis against cluster headaches?
Verapamil
What is the definition of a chronic headache?
Chronic headache is defined as headache that occurs > 15 days a month for >3 months and is not due to organic pathology.
What is the diagnostic criteria for migraine without aura in children?
At least 5 attacks that: last between 2 and 72 hours; include at least two of the following (bilateral or unilateral location, pulsating, moderate-to-severe pain, and made worse with activity); and have at least one associated symptom (nausea/vomiting or photophobia/phonophobia).