peds neuro

Question 1

the most common
type of headache in childhood but generally is less disabling than migraine.

Answer 1

tension headaches

Question 2

Characteristics
Nausea
Abdominal pain (young kids with recurrent and pain 7-10 yo)
Vomiting
Photophobia and phonophobia
Unilateral pain – may vary from side to side
Pulsating/throbbing pain – usually peaks in 1 hour and diminish in a few hours or days
Relief with sleep
An aura
Visual changes, such as dark or blind spots
Family history of headache (80% of children have family history, typically maternal)

Answer 2

Migraine headaches

Question 3

Infants and toddlers may be seen with irritability, sleepiness, pallor, and/or vomiting
Preadolescents experience common symptoms
N/V might not occur
Pain more frontal
Lethargy and sleep often follow
Visual changes are rare
Pain quality is variable
Times between headaches are pain free

Answer 3

Migraine headaches

Question 4

No prodrome or aura
Slowly progressing
Non-throbbing
Pain is dull, aching and bifrontal or occipital with band-like tightness across the scalp
More commonly seen in school-age children
N/V rare
Can last for days/weeks
Psychosocial stress an important factor in triggering head

Answer 4

Tension/ muscle contraction headaches

Question 5

Unilateral, severe, sharp, orbital or supraorbital, or temporal pain usually associated with one of the following: rhinorrhea, lacrimation, flushed skin, nasal congestion, eyelid swelling
Frequently occur at night, waking patient from sleep
Last approximately 15 minutes-3 hours
Pain tends to occur in clusters from a few a night to weeks, then disappears
Negative family history
O2 treatment

Answer 5

Cluster headaches

Question 6

Rare in children
Occurs when a mass causes inflammation or traction on the brain
Headaches increase in severity with accompanying neurological symptoms
Pain is worse in the AM (sometimes with vomiting, after laying down)
Occipital pain; diplopia
Increased pain with straining
Edema of optic disk
Immediate referral to pediatric neurologist!!

Answer 6

Inflammatory headaches (ICP)

Question 7

The following symptoms: Recent behavioral changes, a drop in growth rate, reduced visual acuity, abnormalities upon neurological exam, pain on awakening, coughing, and frequent awakening at night

Answer 7

Indications for neuroimaging studies such as CT scan, EEG, eventually MRI

Question 8

Reduce frequency and severity
Reduce reliance on ineffective medications
Improve quality of life

Answer 8

Goals of therapy

Question 9

is indicated when headaches are frequent enough to interfere with activities (Amitriptyline, Beta blockers). Need to consider EKG prior to starting.

Answer 9

prophylactic treatment

Question 10

Drug of choice to treat headaches in children

Answer 10

tylenol and ibuprofen

Question 11

sumatriptan nasal spray may be used or tablets

Answer 11

On children 12 years or older

Question 12

abortive therapy to interrupt migraine headaches, and prophylactic medications to prevent or reduce the frequency and severity of attacks

Answer 12

general management

Question 13

Counseling for nonorganic headache
Reassure parents and child
If appropriate, child should be taught pain, relaxation, biofeedback, and/or stress management techniques
Quiet rest periods may be needed at school – consult with school nurse
Activities at home should be limited during headache
Child should be returned to school if headache improves during the day – attendance can be a problem
Trigger factors should be avoided

Answer 13

General management

Question 14

Disrupted sleep (not enough more than usual). Stay on regular sleep pattern
Skipped meals
Consumption of certain foods (cheese, chocolate, citrus fruits, foods with nitrates [processed meats], MSG
Alcoholic beverages, especially red wine
Stress
Caffeine overuse/withdrawal

Answer 14

Common Migraine Triggers to be avoided

Question 15

Poor school performance and attendance
Days missed from work
Behavioral problems
Depression
Poor self-esteem
Difficult peer relationships
Increased levels of stress

Answer 15

complications

Question 16

Generally 2 weeks after initiation of treatment: then every 3-6 months
Child/parent should be instructed to go to ER if sudden onset of severe pain or neurological symptoms

Answer 16

follow up

Question 17

1) acute
2) acute recurrent
(or episodic)
3) chronic progressive; and
4) chronic
nonprogressive

Answer 17

headache patterns

Question 18

most worrisome type of headache and deserve thorough evaluation and possibly neuroimaging

Answer 18

chronic progressive headaches

Question 19

headache pain
may be unilateral or bilateral in children, often is frontal
or temporal, and typically is a pounding or pulsing pain.

Answer 19

migraine headache

Question 20

the aura is
characterized by vertigo, ataxia, nystagmus, dysarthria,
tinnitus/hyperacusis, bilateral paresthesias, diplopia, or
visual disturbance. The aura can be unilateral or bilateral
but does not involve motor weakness; the accompanying
headache often is occipital.

Answer 20

migraine types: basilar, confusional, and hemiplegic

Question 21

is characterized by altered mental status, often accompanied by aphasia or impaired
speech and followed by a headache. This state can be triggered by relatively mild head trauma, episode warrants a complete evaluation to rule out other
disorders and intoxication.

Answer 21

Confusion migraine

Question 22

rare
migraine variant that can be familial or sporadic and is
characterized by prolonged hemiplegia, numbness,
aphasia, and confusion

Answer 22

Hemiplegic migraine

Question 23

daily headache is defined as greater or equal to 15 headache days
per month. There are 3 major types. Often they have few or no headache-free days. Typically,
the symptoms that were associated initially with the headache, such as vomiting and severe head pain or aura, diminish somewhat as the headaches become more frequent, although patients still may
have “spikes” of severe head pain at times.

Answer 23

chronic headaches

Question 24

autonomic
symptoms, such as ipsilateral eye redness, tearing, nasal
congestion, rhinorrhea, eyelid swelling, forehead or facial
sweating, miosis, or ptosis.

Answer 24

Trigeminal autonomic cephalalgias (TACs) are rare in children. This diagnostic group includes
cluster headaches, paroxysmal hemicranias, and SUNCT
(short-lasting unilateral neuralgiform headache attacks
with conjunctival injection and tearing)

Question 25

Headaches are the most common presenting symptom of elevated ICP. Typically, these headaches are progressive, may cause nighttime wakening, and are worse
with the Valsalva maneuver or exertion. These children often experience persistent vomiting,
neurologic deficits, lethargy, or personality change

Answer 25

Elevated ICP

Question 26

sometimes
called pseudotumor cerebri, is elevated ICP without evidence of a specific cause. Daily headache is the most
common symptom of and may be associated with
nausea and vomiting and other migrainous features,
but the headache often is poorly characterized. Classic
symptoms include transient obscuration of vision,
tinnitus, and diplopia due to cranial nerve dysfunction

Answer 26

Idiopathic intracranial hypertension (IIH)

Question 27

Posttraumatic headaches develop

Answer 27

within 1 week of
head trauma, concussion, or whiplash.