The Child with Headache Flashcards
4 types of headaches
Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive
Chronic headache history? - questions to ask about a typical episode
Any warning/aura?
Location?
Severity?
Duration?
Frequency?Headache examination
- Growth parameters, OFC, BP
- Sinuses, teeth, visual acuity
- Fundoscopy
- Visual fields (craniopharyngioma)
- Cranial bruit
- Focal neurological signs
- Cognitive and emotional status
Increasing size of OFC could be a sign of??
intracranial pathology
brain tumour, hydrocephalus
Red flag symptoms to ask for to assess for Raised ICP
Aggravated by activities that raise ICP eg. Coughing, straining at stool, bending
Woken from sleep with headache +/- vomiting
Tension headache features
Diffuse, symmetrical
Band-like distribution
Present most of the time (but there may be symptom free periods)
“Constant ache”
Red flat - analgesic overuse headache
Headache is back before allowed to use another dose
Paracetamol/ NSAIDs
Particular problem with compound analgesics eg. Cocodamol
Indications for neuroimaging?
- Features of cerebellar dysfunction
- Features of raised intracranial pressure
- New focal neurological deficit eg. new squint
- Seizures, esp focal
- Personality change
- Unexplained deterioration of school work
Indications for neuroimaging?
- Features of cerebellar dysfunction, ataxia
- Features of raised intracranial pressure
- New focal neurological deficit eg. new squint
- Seizures, esp focal
- Personality change
- Unexplained deterioration of school work
Management of migraine? acute
Acute attack: effective pain relief, triptans
Management of migraine? preventative
at least 1/week
Pizotifen, Propranolol!!!!tt, Amitryptyline, Topiramate, Valproate
TTH acute attacks - can use?
simple analgesia
Tension type headache - prevention medication
Amitryptiline
