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Year 5 - Paediatrics > Headache in a child > Flashcards

Headache in a child Flashcards

1
Q

What are the nutritional causes of migraines?

A

Wine, cheese, chocolate due to tyramine content

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2
Q

What is the main management of headaches in children?

A

60% can be treated conservatively: hydration, lifestyle changes

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3
Q

What is the acute management of headaches?

A

Sumatriptan

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4
Q

What is the MOA of sumatriptan?

A

Sumatriptan selectively binds to and activates serotonin 5-HT1D receptors in the central nervous system (CNS), thereby constricting cerebral blood vessels

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5
Q

What is the International Headache Society classification of headaches? Give examples of each.

A
  1. Primary headaches e.g. migraines, tension-type, cluster (+ other trigeminal autonomic cephalalgias), primary stabbing headaches.
  2. Secondary headaches e.g. raised ICP or SOC
  3. Trigeminal and other cranial neuralgias e.g. root pain from herpes zoster
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6
Q

What are the causes of primary and secondary headaches?

A

Primary - thought to be due to primary malfunction of neurons and their networks

Secondary - due to underlying pathology

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7
Q

Describe the features of a tension-type headache.

A
  • Symmetrical
  • Gradual onset
  • “Tightness/band/pressure”
  • No other symptoms
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8
Q

List 8 causes of secondary headaches.

A

VITAMIN CDEF - Vascular, Inflammatory / Infective, Trauma, Autoimmune, Metabolic, Iatrogenic, Neoplastic, Congenital, Degenerative, Endocrine and Functional

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9
Q

What are the different types of migraine?

A
  1. Migraine with aura
  2. Migraine without aura

Other forms:

  • Familial hemiplegic migraine - caused by inherited calcium channel defect
  • Sporadic hemiplegic migraine
  • Basilar-type migraine - vomiting with nystagmuc and/or cerebellar signs
  • Periodic syndromes - often precursors of migraine
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10
Q

Name 3 periodic syndromes which can precede migraine.

A

Cyclical vomiting - recurrent stereotyped episodes of vomiting and intense nausea associated with pallor and lethargy; well between episodes

Abdominal migraine - idiopathic recurrent, characterised by episodic midline abdominal pain in bouts lasting 1-72 hours; pain is moderate to severe in intensity and associated with vasomotor symptoms, nausea and vomiting; well between episodes

Benign paroxysmal vertigo of childhood - recurrent brief episodes of vertigo without warning, resolving spontaneously in healthy children; normal examination between episodes

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11
Q

What is the most common type of migraine in children?

A

Migraine without aura - accounts for 90% of migraines

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12
Q

Describe the characteristics of migraine without aura. What makes it better/worse?

A
  • Lasts 1-72 hours
  • Bilateral but may be unilateral
  • Pulsatile over temporal or frontal area
  • +/- GI disturbance e.g. vomiting, nausea, abdominal pain
  • Photophobia
  • Phonophobia

Aggrevated by physical activity and relieved by sleep.

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13
Q

Describe the characteristics of migrain with aura.

A
  • Headache preceded by aura
  • Absence of symptoms between episodes
  • Lasts a few hours
  • Relived by lying down in quiet, dark place
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14
Q

What types of aura can precede a migraine with aura?

A

Visual, sensory or motor. Most commonly:

  1. negative phenomena e.g. hemianopia or scotoma
  2. positive phenomena e.g. fortification spectra

NB: Sometimes aura can occur without the headache

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15
Q

Does FH predispose to migraine?

A

Genetic predisposition with 1st and 2nd degree relatives often affected

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16
Q

What are the triggers of migraine in children?

A

Usually triggered by disturbance in inherent biorhythms e.g. late nights/early rises, stress at home or at school.

Foods are rarely a reliable trigger e.g. cheese, chocolate, caffeine.

In girls, menstruation of taking the oral contraceptive pill can be related to migraine.

17
Q

What are the characteristics of a headache due to SOC or raised ICP?

A
  • Worse when lying down
  • Morning vomiting
  • Night-time waking
  • Change in mood, personality, educational performance
  • Visual field defects
  • CN abnormalities e.g. diplopia, squint, facial nerve palsy
  • Abnormal gait
  • Torticollis (tilting of the head)
  • Growth failure
  • Papilloedema (late)
  • Cranial bruits (AVM but rare)
  • Early or late puberty
18
Q

Which space-occupying lesions can cause…?

  1. visual field defects
  2. false localising signs
  3. facial nerve palsy
  4. growth failure
A
  1. lesions pressing on optic pathways e.g. craniopharyngioma
  2. abducens nerve (CNVI) - has a long intracranial course and can cause false localising signs for the SOC –> diplopia, squint, inability to abduc eye past midline
  3. pontine lesions
  4. craniopharyngioma or hypothalamic lesions
19
Q

What should you ask about in a headache history? What to look for on examination?

A
  • Frequency, duration, character, position, radiation, triggers,, relieving and exacerbating, aura, premonitory symptoms
  • Emotional/behavioural problems at home or school
  • Vision checked
  • Head trauma
  • Alcohol, solvent or drug abuse
  • Analgesia over-use

Physical signs:

  • Visual acuity - refractive errors
  • Sinus tenderness - sinusitis
  • Pain on chewing - TMJ malocclusion
  • BP - for hypertension
20
Q

What are red flag symptoms for headache?

A
  • Growth failure
  • Visual field defects - craniopharyngioma
  • Squint
  • CN abnormalities
  • Torticollis
  • Abnormal coordination - for cerebellar lesions
  • Gait - UMN or cerebellar lesions
  • Fundi - papilloedema
  • Bradycardia
  • Cranial bruits - AVM
21
Q

What is the definition of chronic daily headache? What is a common cause?

A

Headache on 15 or more days a month

This is a rebound headache in patients with primary headaches/migraines caused by medication overuse when using analgesics or triptans on more than 2 days a week. Withdrawing from the offending medication will resolve this within about 2 weeks.

22
Q

What are the investigations for headache?

A

History and examination

Imaging - only in presence of red flag symptoms

23
Q

What is the management of headache?

A

Rescue treatments

  1. Analgesia - paracetamol, NSAIDs taken early
  2. Antiemetics - prochlorperazine or cyclizine
  3. Triptans - nasal sumatriptan (5HT1 agonist) with NSAID/paracetamol is useful for attacks
  4. Physical treatments - cold compress, warm pads, topical forehead balms

Prophylaxis

  1. Na channel blockers - topiromate or valproate
  2. Beta-blockers - propranolol (CI in asthma)
  3. Trycyclics - pizotifen (5HT2 antagonists) but cause weighht gain and sleepiness; amitriptyline can cause arrhythmias.
  4. Acupuncture

Psychosocial support

  1. Psychologist - to ameliorate stressor e.g. bullying, anxiety, stress
  2. Relaxation/self-regulation techniques

Year 5 - Paediatrics (91 decks)

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