16.3 Headaches in Children

Question 1

headaches in younger affect boys or girls?

Answer 1

boys

Question 2

headaches in older kids girls or boys?

Answer 2

girls

Question 3

what headache patterns are most sinister

Answer 3

Acute

chronic progressive

Question 4

most likely cause of acute recurrent headaches?

Answer 4

migraines

Question 5

most likely cause of chronic non-progressive headache?

Answer 5

tension-type

Question 6

what is the Prensky migraine criteria?

Answer 6

3 of:

• abdo pain, N+V
• unilateral headache
• pounding/throbbing pain
• complete relief after sleep
• aura
• FHx

Question 7

kids normally don’t have what with migraines?

Answer 7

normally don’t have aura

Question 8

how to differentiate a migraine aura from a seizure aura?

Answer 8

migraine take longer onset of aura

Question 9

Chronic progressive headache ddx?

Answer 9

• space occupying lesion

- idiopathic intracranial HTN

Question 10

other causes of chronic headaches?

Answer 10

Trauma
ocular
sinusitis
venous sinus thrombosus
post seizure

Question 11

red flag symptoms history/exam

Answer 11

• night time awakening/early morning headache
• progressive worsening
• occipital headaches
• exetion/coughing
• diplopia/seizures
• behavioural
• abnormal neurological exam/HTN/papilledema/growth

Question 12

which symptoms in migraine are unusual?

• vomiting
• double vision
• vertigo
• no Fx
• reversible focal neuro
• persistent headache?

Answer 12

• diplopia
• lack of fx
• persisten headache

Question 13

Mx of migraine meds wise?

Answer 13

avoid meds if possible

Question 14

Acute mx of migraine meds?

Answer 14

• ibuprofen: acute onset
• panadol
• sumatriptan 5mg to 20mg oral and nasal

Question 15

antiemetics for migraine?

Answer 15

ondansetron wafers

Question 16

migraine resting place?

Answer 16

rest in dark room

Question 17

max analgesia for migraine in kids?

Answer 17

analgesia <2-3x/week

triptans <6/month

Question 18

5-HT1 agonists?

Answer 18

sumatriptan oral/nasal
rhizotriptan
zolmitriptan

Question 19

migraine preventive Rx? when? what?

Answer 19

• if day-to-day impairment
• takes 4-6 weeks to work
• low dose:
• propranolol
• amitryptyline
• sodium valproate
• topiramate
• flunarizine
• pizotifen
• cyproheptadine
• riboflavin/magnesium