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Adv Prac Child Adolescent 6036 Test 1 COMPLETE ☑️ > Module 2 (b) Pediatric Neurology - Headaches > Flashcards

Module 2 (b) Pediatric Neurology - Headaches Flashcards

1
Q

Tics

A
  1. Sudden, brief intermittent movements (motor tics) or utterances (vocal tics)
  2. Almost always briefly suppressible
  3. Usually associated w/ awareness of an urge to perform the movement
  4. Up to 25% of children
  5. Some tics (PANDAS) follows Strep infection
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2
Q

TICS

-Simple Motor and complex tics?

A
  1. Simple Motor — Nose wrinkling, eye twitching, lip biting, grimacing, shoulder shrug
  2. Complex Motor — Kicking, skipping, smelling things
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3
Q

TICS

-Simple Vocal and Complex Vocal

A
  1. Simple Vocal — Coughing, throat clearing, sniffing, grunting
  2. Complex Vocal — Repeating words/phrases, animal sounds, yelling
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4
Q

TICS

-Tourette Syndrome

A
  1. Persistent vocal and motor tics
  2. Onset age 2-15 yrs
  3. Associated w/ ADHD, OCD and behavioral problems
  4. Treatment
    - Behavioral interventions
    - Pharmacologic Therapy for Disabling and bothersome TICS
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5
Q

TICS Patient Education

A
  1. Increased Tics associated with
    - Focusing on the tic
    - Stressful situations
    - Lack of sleep
    - Holding tics in for a long time
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6
Q

Headaches

-Info

A
  1. Very common — 60% of children, 90% of adolescents
  2. Etiology
    - Primary Vs Secondary
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7
Q

Secondary Headaches

A
  1. Acute illness
  2. Post-traumatic HA
  3. Medications
  4. HTN — only hypertensive crisis
  5. Intracranial Hemorrhage
  6. Hydrocephalus
  7. CNS Tumor
  8. Idiopathic Intracranial HTN
  9. Medication overuse HA
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8
Q

Imaging In Children w/ Headaches

A
  1. Imaging is indicated w/ HA + Abnormal neurological exam — MRI w/out Contrast is imaging of choice if HA is only concern
  2. Think of imaging with
    - New onset HA in an immunosuppressed child
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9
Q

HA imaging Algorithm

A
  1. FMH of Primary HA + Normal Neuro exam + Duration > 3-6 months - NO NEED TO IMAGE
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10
Q

Signs and Sx’s of Increased ICP

A
  1. Abnormal Neuro Exam
  2. HA
  3. Recurrent or persistent N/V
  4. Papilledema
  5. Seizures
  6. Macrocephaly
  7. Behavioral changes
  8. Lethargy
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11
Q

Neurocutaneous Syndromes

-Neurofibromatosis (NF-1)

A
  1. Multiple cafe au lait spots
  2. Axillae or inguinal freckling
  3. Skin neurofibromas
  4. Luis h nodules (iris)
  5. NF-1 has a strong association w/ CNS tumor
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12
Q

Medication Overuse Headache

A
  1. Limit HA medication to less than 15 days per month
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13
Q

Primary HA’s

A
  1. Tension-Type HAs
  2. Migraine — Menstrual-related Migraine and childhood migraine precursors
  3. Trigeminal Autonomic Cephalagias
  4. Less Common Primary HAs
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14
Q

Primary HAs

-Tension-Type HA

A
  1. Bilateral, non-throbbing head pain of mild to moderate intensity (MOST COMMON)
    - 30 minutes to 7 day duration
    - NO N/V
    - May have photophobia or phonophobia
    - Not aggravated by routine physical activity
  2. May have tightness/tenderness in occipital or cervical region
  3. Non-Pharmacologic treatment + Limited use of analgesia
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15
Q

Phases of a Migraine Attack

A
  1. Prodrome — few hrs to days before
  2. Aura — 5 to 60 minutes prior to HA
  3. Migraine — Starts small and gets worse — 4-72 hrs — Needs to last at least 2 hrs for diagnosis
  4. Postdrome — 24-48 hrs — evidence that migraine has occurred
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16
Q

Migraine w/out Aura

A
  1. More common than with Aura
  2. Recurrent HA lasting 2-72 hrs
  3. Moderate to severe intensity
  4. Pulsating quality
  5. Associated w/ nausea, photophobia, phonophobia
  6. Aggravated by routine physical activity
  7. Location typically frontal, bilateral, or holocephalic in children
17
Q

Migraine W/ Aura

A
  1. 14-30% and less common than w/out aura
  2. Typically precedes HA onset
  3. Gradual development over at least 5 minutes
  4. Duration no longer than an hour
  5. Transient and fully reversible
18
Q

Migraine W/ Aura

-Types of Auras

A
  1. Visual
    - Small bright spot or small area of visual loss
    - Scintillating scotoma or squiggles
  2. Sensory
    - Tingling in one limb or one side of the face
    - Altered perception or sensation
  3. Speech/Language
    - Dysphasia
    - Word-finding difficulty
    - Impaired comprehension
19
Q

Migraine w/ Brainstem Aura

A
  1. No motor weakness
  2. Vertigo, dysarthria, tinnitus, diplopia, bilateral visual Sx’s, bilateral paresthesias, decreased consciousness, hypacusis
20
Q

Hemiplegic Migraine

A
  1. Aura includes motor weakness
    - Typically starts in the hand and spreads up
    - Typically unilateral
  2. May take hrs to resolve
  3. Familiar vs sporadic

Get imagine w/ these children **

21
Q

Retinal Migraine

A
  1. Monocular visual aura
  2. Sudden loss of vision or perception of bright light in ONE eye only
  3. Spreads gradually
  4. Subsequent HA typically ipsilateral and Periorbital
22
Q

Menstrual Migraine

A
  1. Typically w/out aura
  2. Can have MM and non-MM.
  3. HA is caused by drop in estrogen levels and occurs a few days before menstruation
23
Q

Cyclic Vomiting Syndrome

A
  1. Repeated and usually stereotypical episodes of N/V that last for hours to days
  2. Well between episodes
  3. Often concurrent abdominal migraine
24
Q

Abdominal Migraine

A
  1. Recurrent episodes of abdominal pain w/ at least 2 additional Sx’s
    - Anorexia, N/V, and pallor
  2. Pain is midline or poorly localized; dull and moderate to severe intensity
  3. HA is not a prominent ft during attacks
  4. No photo/phonophobia
  5. Well between attacks
25
Q

Less Common Primary HAs

-Trigeminal Autonomic Cephalagias

A
  1. Short HA attacks w/ prominent ipsilateral cranial parasympathetic autonomic features
    - Conjunctival injection and/or tearing
    - Nasal congestion and/or Rhinorrhea
    - Eyelid swelling
    - Forehead and facial sweating
    - Miosis and/or ptosis

RED FLAG HEADACHES ***

26
Q

Less Common Primary HAs

-4 types

A
  1. Primary Stabbing HA
  2. Primary cough HA
  3. Primary exertional HA
  4. New daily persistent HA

RED FLAG HA’s

27
Q

Management of Primary HAs

-Lifestyle Habits

A
  1. Consistency in
    - Sleep
    - Nutrition
    - Low Stress
    - Hydration
28
Q

HA Rescue Treatment

A
  1. Early
  2. Specific
  3. Comprehensive
  4. Appropriate

One of the biggest risk factors for having more migraines is INCOMPLETE TX of an individual attack **TEST

29
Q

HA Rescue Treatment

-Tension-Type HA

A
  1. Distracting activity or rest
  2. Warm or cool compresses
  3. If HA worsens, Tx w/ acetaminophen or NSAID
30
Q

HA Rescue Treatment

-Migraine

A
  1. Acetaminophen or NSAID +/- Triptan

2. Set limits for use — NSAID <15 days a month, Triptan < 10 days a month

31
Q

HA Rescue Treatment

-Antiemetic

A
  1. Early-onset nausea: metoclopramide, ondansetron
  2. Late onset Nausea and/or need sleep to end HA
    - Promethazine (Phenergan)
    - Prochlorperazine (Compazine) + diphenhydramine (Benadryl)
32
Q

Rescue Treatment w/ NSAIDS

A
  1. Ibuprofen (Motrin, Advil) — 10mg/kg/day Max 40mg/kg/day
  2. Naproxen (Aleve) — 5-7mg/kg/dose, Max 1000mg/day —Available as liquid Rx 125/5mls
  3. Diclofenac sodium (Cambia) — 2-3mg/kg/day / 2-4 times a day, Max 200mg/day
  4. Ketorolac (Torodol) — 10 mg every 4-6 hrs orally, Max 40 mg/day
33
Q

HA Rescue Treatment

-Triptans

A
  1. Rizatriptan (Maxalt) — Fastest acting Triptan
34
Q

HA management Prevention

A
  1. Amitriptyline and Topiramate — MOST COMMONLY prescribed agents
    - Goal is 50% change over 3 months
35
Q

HA Prevention Indications

A
  1. HA’s significantly impact quality of life and daily routine
  2. Frequent HAs
    - >/=4 migraines/month or >/=8 headache days/month
  3. Infrequent but prolonged headaches
  4. Sub-optimal rescue treatment
  5. Neuroprotection — Migraine w/ aura can be a risk for CVA
  6. Patient/family preference
  7. Use S/E as a pro
36
Q

Headache Prophylaxis

-General principles

A
  1. Low and slow
  2. Adequate trial of 3 months necessary to determine efficacy
  3. Set realistic goals
    - 50% change over 3 months
    - Improved response to rescue Tx
    - migraine =4/month, functional w/in about an hour
    - NOT complete headache freedoms, BUT improved QOL
37
Q

Focal Seizure Testing

A
  1. Always get MRI if pt has focal seizure

Adv Prac Child Adolescent 6036 Test 1 COMPLETE ☑️ (5 decks)

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