Flashcards in Headache in child/adolescent COPY Deck (21):
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)
Common causes of Headaches
Raised intracranial pressure
features suggesting uncommon but serious underlying pathology e.g. brain tumour, meningitis, intracranial bleed.
Acute onset of severe pain
worse on lying down
Developmental regression or personality change
Increasing head circumference
Focal neurological signs
Presence of VP shunt
Consistent location of recurrent headaches,
age under 3 yr
Mx for migraine
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
Mx for tension headaches
reassurance that there is no serious pathology
Simple analgesia - paracetamol 15mg/kg
Address any underlying stress or anxiety in child's life.
Minimise school absence
recognise headaches requiring urgent mx
Raised intracranial pressure
- Worse in mornings and with lying down
- focal neurological signs
- HTN and bradycardia if severe.
Types of headaches
Clinical features of tension headache
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
Cause of tension headache
contraction of neck or temporal muscles and are felt as a constricting band like ache
Differentiate migraine from tension headache
Migraine from tension type
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.
Hx for PC headache
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.
Examination for headache
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
Cause of migraine
constriction followed by dilatation and pulsation of intracranial arteries.
Clinical presentation of migraine
start with aura
Throbbing unilateral headache with nausea and vomiting
Resolves with sleep
In really young child it can be bilateral and children described as going pale.
Physical examination is normal.
Sleep deprivation and stress can predispose
how to dx a migraine
Episodic occurrence of headache
Completely well between attacks
Aura 20% in children
Nausea - 90%
Positive FmHx - material
Impairment of normal function during attack
Attack lasts between 1 and 72 hr.
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
Cause of cluster headache
NT activity around superficial temporal artery
Tx of cluster headache
Sumatriptan (serotonin agonist ) used acutely and calcium channel blocker e.g. nifedipine for recurrent attacks.
Common causes of headache in childhood and adolescent
Inter current infection
Uncommon but important causes of headache in children and adolescence
Acute severe - meningitis, brain tumour, intracranial bleeding
Chronic - tumour, benign intracranial HTN.