Headache in child/adolescent Flashcards Preview

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Flashcards in Headache in child/adolescent Deck (21):
1

How to assess hydration status

Ask - thirst, urine output (1-5ml/kg/hr or 4-6 in 24hr)
Look - sunken eye, moist Mucous membranes
Feel - Fontanelles, central CRT, Skin tumour, pulse rate (weak, thready, fast)

2

Common causes of Headaches

tension headache
Eye strain
Migraine
sinusitis
Central caries
Raised intracranial pressure
Infection
analgesic headache
Hypertension

3

features suggesting uncommon but serious underlying pathology e.g. brain tumour, meningitis, intracranial bleed.

Acute onset of severe pain
worse on lying down
Associated vomiting
Developmental regression or personality change
Unilateral pain
HTN
Papilloedema
Increasing head circumference
Focal neurological signs
Presence of VP shunt
Consistent location of recurrent headaches,
age under 3 yr

4

Mx for migraine

Rest
Simple analgesia
adequate sleep
reduce stress
Avoid cheese, chocolate, citrus fruits, nuts and caffeinated drinks
Prophylaxis - beta blockers or pizotifen
In adolescent serotonin agonists eg sumitriptan during acute attack.
May cause post migraine third palsy or hemiparesis

5

Mx for tension headaches

reassurance that there is no serious pathology
Rest
Sympathy
Simple analgesia - paracetamol 15mg/kg
Address any underlying stress or anxiety in child's life.
Minimise school absence

6

recognise headaches requiring urgent mx

Raised intracranial pressure
- Worse in mornings and with lying down
- Vomiting
- Papilloedema
- focal neurological signs
- HTN and bradycardia if severe.

7

Types of headaches

tension headache
Migraine

8

Clinical features of tension headache

Band-like pressure
Worse late in the day
precipitated by stress
common in older school age children
worse towards end of day
Doesn't interfere with sleep
Examination is normal

9

Cause of tension headache

contraction of neck or temporal muscles and are felt as a constricting band like ache

10

Differentiate migraine from tension headache

Migraine from tension type
POUND
P- pulsatile headache
O -4-72 hOurs duration
U - Unilateral, not bilateral
N - Nauseas and/or vomiting
D - disabling headache
If 4-5 features than likely to be migraine.

11

Hx for PC headache

Fmhx
Good description of headache
- unilateral, bilateral
Associated symptoms e.g. vomiting, blurred vision
worse in the morning or when lying down - RICP
visual auras eg halos or zigzag lines = migraine
Photophobia and neck stiffness in addition to headache suggest meningitis
ask about nasal congestion and pain in the teeth or ears as infection around the skull can present as headache.
Bullying

12

Examination for headache

Record BP
feel pulse - Bradycardia
Examine fundi - signs of pailloedema
Neuro for focal signs
- Cerebellar - nystagmus, ataxia, intention tremor. Meduloblastoma
- Infratentorial - CN palsies
- Cerebral - focal seizures, spasticity
- Pituitary - Endocrine dysfucntion, visual field defects. Craniopharyngiomas.
Evidence of dental caries, sinus tenderness, audible cranial bruits

13

Cause of migraine

constriction followed by dilatation and pulsation of intracranial arteries.

14

Clinical presentation of migraine

start with aura
Throbbing unilateral headache with nausea and vomiting
Resolves with sleep
Pulsing pain
Photophobia
Phonophonia
In really young child it can be bilateral and children described as going pale.
Physical examination is normal.
Sleep deprivation and stress can predispose

15

how to dx a migraine

Episodic occurrence of headache
Completely well between attacks
Aura 20% in children
Nausea - 90%
Throbbing headache,
Positive FmHx - material
Impairment of normal function during attack
Attack lasts between 1 and 72 hr.

16

Clinical presentation of cluster headache

sudden onset or very severe unilateral periorbital pain
Attacks occur in clusters a few times a day for periods of weeks.
Pain in non pulsatile
Occur night and day
Exacerbated by alcohol
unilateral eye redness, orbital swelling or tears

17

Cause of cluster headache

NT activity around superficial temporal artery

18

Tx of cluster headache

Sumatriptan (serotonin agonist ) used acutely and calcium channel blocker e.g. nifedipine for recurrent attacks.

19

Common causes of headache in childhood and adolescent

Inter current infection
Tension headaches
Migraine

20

Uncommon but important causes of headache in children and adolescence

Acute severe - meningitis, brain tumour, intracranial bleeding
Chronic - tumour, benign intracranial HTN.

21

Other diseases that cause headaches

Fever without associated meningism - URTI, pneumonia, septicaemia
Local sinusitis - focal facial tenderness, otitis media
History of recent head injury
Meningitis - Irritability, decreased consciousness, petechiae/purpura, photophobia/neck stiffness
SAH - sudden onset, vomiting, often occipital
Rebound/overuse headache