Peds NEURO 2 - HA, Cerebral Palsy, Spina Bifida, Chiari Flashcards
MCC of HA
URI due to strep
The following are ___________ causes of HAs
Meningitis, encephalitis, cerebral abscess
Subarachnoid hemorrhage
Increase ICP
life-threatening
What are other causes of HAs?
Toxin/substance abuse
Postictal phase
HTN (*consider pre-eclampsia in adolescent females & nephrotic syndrome)
Psychogenic
Sleep deprivation
What must you ask about when trying to figure out the cause of a child’s HA?
**Ask about pattern, school absences, changes at home**
What are the 4 types of HA patterns?
Acute
Acute Recurrent
Chronic progressive
Chronic Nonprogressive/Daily
Acute HA pattern (single episode w/o prior hx) is usually due to what?
febrile illness
Acute recurrent HA pattern (episodes separated by pain-free intervals) is usually due to what?
typical migraine
tension HA
Chronic progressive pattern (most concerning pattern) is usually due to what?
inc. ICP
Chronic Nonprogressive/Daily pattern (>4 mo or >15 mo) is usually due to what?
psych factors
Most severe on awakening, awaken in middle of night
Severely exacerbated by coughing or bending
Acute onset without previous history
Present daily with progressive worsening
Accompanied with vomiting
Focal neurologic signs
Aggravated by Valsalva-like maneuvers
What do these sx describe?
A worrisome condition
If HA worse when lying flat, think increased _____.
If HA worse when lying flat, think increased ICP
Sx of what?
_**Frequently begins in childhood**_
•Periodic headaches w/vomiting and relieved by rest
Frontal, bitemporal or unilateral pounding/throbbing for 2-72h
Sx relieved by sleep
Possible visual aura 15-30 minutes prior
**N/V, abd pain, phono/photophobia**
Migraines
Step 1 in management of migraines
Eliminate triggers: diet, menses, stress
Inc. exercise & sleep
HA diary
Migraines: Acute treatment?
NSAIDs, acetaminophen
triptans (nasal sumatriptan approved >12 y/o)
antiemetics
When would you use prophylaxis for migraines and what is it?
for kids with frequent, prolonged or disabling HAs
<6yo: cyproheptadine
>6yo: propranolol, amitriptyline (TCA), topiramate, others (PAT)
What is the prognosis for migraines?
Good; improve with time, some may continue to have HAs
Etiology of what condition?
Inc. ICP w/o space-occupying lesion or obstruction
Cause unknown (likely multifactorial)
Pseudotumor Cerebri AKA idiopathic intracranial hypertension (IIH)
Clinical Px of which condition?
MC in females of childbearing age; occurs in peds 11+
Inc. ICP sx: HAs, blurred vision, diplopia, vision loss
HA worse at night, aggravated by sudden movement
neck stiffness, tinnitus, dizziness, paresthesias
Pseudotumor Cerebri (IIH)
What is seen on PE of Pseudotumor Cerebri (IIH)?
What is the main complication of this condition?
PE: Papilledema, abnormal visual field testing
Complication: vision loss