Headache Flashcards

1
Q

What are the three main groups of headaches in children?

A

Tension, migraine, and organic.

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2
Q

What is the most common type of headache in children?

A

Tension, followed by migraine.

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3
Q

List 5 serious causes of headache.

A

Infection, tumor, intracranial hemorrhage, CO poisoning, and hypertensive encephalopathy.

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4
Q

What is the typical pattern of symptoms seen in patients with tension headaches?

A

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.

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5
Q

What are three general causes of organic headaches?

A

Structural abnormalities, metabolic diseases, and infectious etiologies.

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6
Q

What is the preferred imaging modality for patients suspected of having an organic headache?

A

MRI is the preferred imaging modality, but CT may be used if MRI is unavailable.

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7
Q

What medications are associated with the development of pseudotumor cerebri in adolescents?

A

Doxycycline, tetracycline, and vitamin A (when it causes hypervitaminosis, such as in patients using retinoic acid for treatment of acne).

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8
Q

What condition should be considered in an adolescent taking doxycycline or tetracycline for treatment of their acne who then presents with new headaches?

A

Pseudotumor cerebri

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9
Q

List 15 warning signs of organic headaches.

A

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.

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10
Q

Describe the typical presentation of cluster headaches.

A

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).

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11
Q

Describe the age and gender distribution of cluster headaches.

A

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).

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12
Q

What is the best treatment for acute symptoms of cluster headaches?

A

Oxygen. Ihalation of oxygen at 6L/min for 15 minutes is usually rapidly abortive.

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13
Q

What is the drug of choice for prophylaxis against cluster headaches?

A

Verapamil

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14
Q

What is the definition of a chronic headache?

A

Chronic headache is defined as headache that occurs > 15 days a month for >3 months and is not due to organic pathology.

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15
Q

What is the diagnostic criteria for migraine without aura in children?

A

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).

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16
Q

What is the diagnostic criteria for migraine with aura in children?

A

At least 2 attacks with the following features (gradual development of autonomic aura, aura that is fully reversible, aura present <1 hour, or headache within one hour of aura); one or more fully reversible aura symptoms (visual, sensory, speech, motor, brainstem, or retinal); and at least two of the following characteristics (at least one aura symptom spreads gradually over ≥5 minutes and/or ≥2 symptoms occur in succession; each individual aura symptom lasts 5-60 minutes; at least one aura symptom is unilateral; or the aura is accompanied, or followed within 60 minutes, by headache).

17
Q

How do basilar artery migraines classically present?

A

They occur more commonly in adolescent girls and present with vertigo, syncope, and dysarthria. Some also have visual alterations and loss of consciousness.

18
Q

How do hemiplegic migraines classically present?

A

The child has weakness on one side of the body with or without aphasia which can last hours to days.

19
Q

How does ophthalmoplegic migraine classically present?

A

This presents as an abnormality of eye movements, usually CN3. CN 4 and 6 are less commonly affected.

20
Q

How does confusional migraine classically present?

A

Patients present in a profoundly confused state that lasts for hours.

21
Q

What three drugs are used as abortive therapy for migraines in children and adolescents?

A

Almotriptan is approved for migraine pain in 12-17 year olds and rizatriptan is approved for children 6-17 years of age. Nasal sumatriptan is recommended for use in adolescents >18 years of age.

22
Q

Which 6 drugs are used for prophylaxis against migraines in children and adolescents?

A

Topiramate is approved for use in patients 12-17 years of age. Most data is anecdotal, but other frequently used agents include cyproheptadine, valproate, calcium channel blockers, propranolol, and amitriptyline.

23
Q

In what (17) situations would it be appropriate to order CT or MRI for evaluation of headache in a child?

A

Occipital headaches (rare in children, usually have a structural cause); unexplained academic decline or behavioral changes; abnormal neuro exam; fall-off in growth; headache that awakens the child from sleep; early morning headaches which increase in frequency and severity over time; headache with focal seizure; papilledema; migraine headache, followed by seizure; headache with vomiting in the absence of a family history of migraine; cluster headaches; any child < 3 years old with chief complaint of headache; brief coughing episode resulting in headache; increasing “crescendo” headaches; persistent focal headaches; increased head circumference; increase in severity of headache with Valsalva maneuver.