Pediatric Headache Flashcards
- Incident increases in the post-pubescent female and decreass in the post pubescent male
- accounts for 75% of headaches in young children referred for neurological consultation
- acute, recurrent, severe
- unilateral or bilateral
- in 90% of cases at least one parent has a history (autosomal dominant inheritance)
Pediatric Migraine
attacks fulfillng criteria with aura and criterion B below
- fully reversible motor weakness
- fully reversible visual, sensory and/or speech/language symptoms
- note: motor symptoms generally last less than 72 hours but, in some patients, motor weakness may persist for weeks
Hemiplegic Migraine
Recurrent episodes of head tilt with vomiting, pallor, irritability, ataxia or drowsiness usually in the first few months of life
Benign paroxysmal torticollis
recurrent attacks of brief (< 1 min) disequilibrium, may be associated with appearing frightened, nystagmus, diaphoresis, N/V
BPV
recurrent attacks of vomiting with return to baseline in between
Cyclic vomiting
visual hallucinations and bizarre perceptual distortions that accompany or precede a headache, no amnesia
Alice in wonderland syndrome
recurrent episodes of abdominal pain in a healthy child who is otherwise normal between attacks. Pain is typically midline or poorly localized. At least two other features: anorexia, N/V, pallor
Abdominal Migraine
- Headache < 3 months caused by traumatic injury to the head. Headache developed within 7 days of injury, of regaining consciousness or of discontinuation of medications that impair ability to sense headache
- headache resolved within 3 months
Post traumatic headache
- chronic progressive headache increasing in frequency and severity over time
- wakes child from sleep or occurs upon waking
- associated with disorientation or confusion: nausea/vomiting, visual disturbance, ataxia, abnormal eye movements, seizures, weight loss, motor findings
Tumor
tumor location clues
Posterior fossa tumors
- nausea and vomiting, headache, abnormal gait and coordination
Brainstem tumors
- abnormal gait and coordination, and cranial nerve palsies
Spinal Cord tumors
- back pain and/or weakness and abnormal gait
Supratentorial and central tumors
- symptoms are generally not specific, most commonly headache
Signs of increased ICP
- Headache
- nausea and vomiting
- ocular palsises (ex. cranial nerve VI palsy)
- altered LOC
- papilledema
- cushings triad (increased systolic BP, widened pulse pressure, bradycardia
- typically in young, obese women
- frequently described as frontal, retro-orbital, pressure-like
- secondary causes: cerebral venous thrombosis, medications (isotretinoin, tetracyclines primarily)
- symptoms: tinnitus, transient visual obscurations, diplopia, neck or back pain
- findings: papilledema CN VI palsy
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Idiopathic intracranial hypertension
Next steps for a subarachnoid hemorrhage?
CT without contrast most sensitive
nimodipine, hydration
neurosurgical intervention
- acute clinical picture
- diffuse headaches, fever
- menigeal signs
- impaired consciousness
- neurological deficits, seizures
- systemic signs- shock, rash
Meningitis, encephalitis
get LP, antibiotics, and fluid electrolyte managment
when to start preventative medications for migraine?
- when headaches are interfering with daily lifestyle
- headaches that occur 1-2+ times per week
- when headaches are severe or debilitating when they occur, regardless of frequency
- when acute treatments are not effective or there is an overuse of acute treatments
- hemiplegic migraine
medications should be taken daily and may need 6-8weeks to take effect
