Headaches Flashcards
Give examples of causes of headaches in children
- Tension headaches
- Migraines
- Ear, nose and throat infection
- Analgesic headache
- Problems with vision
- Raised intracranial pressure
- Brain tumours
- Meningitis
- Encephalitis
- Carbon monoxide poisoning
Briefly describe tension headaches and its clinical features
Tension headaches are very common. Classically they produce a mild ache across the forehead and pain or pressure in a band-like pattern around the head. Tension headaches comes on and resolve gradually and don’t produce visual changes or pulsating sensations. They are typically symmetrical.
Symptoms may be very non-specific in younger children. They may become quiet, stop playing, turn pale or become tired. They tend to resolve more quickly in children compared with adults, often within 30 minutes.
What may trigger tension headaches in children?
There are certain triggers for tension headaches in children:
- Stress, fear or discomfort
- Skipping meals
- Dehydration
- Infection
Briefly describe management of tension headaches
Management is with reassurance, analgesia, regular meals, avoiding dehydration and reducing stress.
What are the different types of migraine?
There are several types of migraine:
- Migraine without aura
- Migraine with aura
- Silent migraine (migraine with aura but without a headache)
- Hemiplegic migraine
- Abdominal migraine
Briefly describe migraines and its clinical features
Migraines are a complex neurological condition that cause headache and other associated symptoms. They occur in “attacks” that often follow a typical pattern.
Migraines present differently to tension headaches. Symptoms tend to be:
- Unilateral
- More severe
- Throbbing in nature
- Take longer to resolve
Migraines are often associated with:
- Visual aura
- Photophobia and phonophobia
- Nausea and vomiting
- Abdominal pain
Briefly describe the management of migraines in children
Management of migraines in children:
- Rest, fluids and low stimulus environment
- Paracetamol
- Ibuprofen
- Sumatriptan
- Antiemetics, such as domperidone (unless contraindicated)
Briefly describe the use of prophylactic treatment for migraines in children
Where the migraines are having a significant impact on life, for example frequent attacks or missing school, prophylactic treatment can be tried to reduce the frequency and severity of the migraines. This is usually guided by a specialist.
Options for migraine prophylaxis are:
- Propranolol (avoid in asthma)
- Pizotifen (often causes drowsiness)
- Topiramate (girls with child bearing potential need highly effective contraception as it is very teratogenic).
What are abdominal migraines?
Children are more likely than adults to suffer with a condition called abdominal migraine. This may occur in young children before they develop traditional migraines as they get older. They present with episodes of central abdominal pain lasting more than 1 hour. Examination will be normal. There may be associated:
- Nausea and vomiting
- Anorexia
- Headache
- Pallor
What infections should always be checked as a cause of headaches in children?
Infections can cause headaches in children. In a child with a new headache, always check for symptoms and signs of a viral upper respiratory tract infection, otitis media, sinusitis and tonsillitis. The headache should resolve along with the infection. Paracetamol and ibuprofen can be helpful for symptomatic relief.
How does a sinusitis headache present?
Sinusitis causes a headache associated with inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses. This usually produces facial pain behind the nose, forehead and eyes. There is often tenderness over the effected sinuses, which helps to establish the diagnosis. Sinusitis usually resolves within 2 – 3 weeks. Most sinusitis is viral.
