Headache in Children

Question 1

What is the most common cause of primary headache in children?

Answer 1

Migraine without aura

Question 2

What are the IHS (International Headache Society) criteria for diagnosing migraine without aura in a child?

Answer 2

• A- >= 5 attacks fulfilling B to D
• B - Lasts 4-72 hours.
• C- Headache has at least two of the following four features:
  
  • Bilateral or unilateral (frontal/temporal) location
  • Pulsating quality
  • Moderate to severe intensity
  • Aggravated by routine physical activity
• D- At least one of the following accompanies headache:
  
  • Nausea and/or vomiting
  • Photophobia and phonophobia.

Question 3

How do you manage migraine without aura in a child?

Answer 3

1. Acute - Ibuprofen - more effective than paracetamol. ​
   
   • (NOTE: Triptans are only to be used by a specialist. Sumatriptan nasal spray is the only effective triptan but is poorly tolerated as it causes a bad taste in the throat. Orodispersible zolmitriptan (unlicensed) is widely used in children aged 8 years and older.)
   • Side Effects of triptans - tingling, heat and heaviness/pressure sensations.
2. Prophylaxis
   
   1. ​First line - pizotifen and propranolol.
   2. Second line - valproate, topiramate and amitryptiline.

Question 4

What is the second most common cause of headache in children?

Answer 4

Tension-type headache.

Question 5

What are the IHS criteria fr diagnosing TTH in chidlren?

Answer 5

• A - atleast 10 previous headache episodes fulfilling features B to D.
• B - Headache lasting from 30 minutes to 7 days.
• C - At least two of the following pain characteristics:
  
  • Pressing/tightening (non/pulsating) quality
  • Mild or moderate intensity (may inhibit but does not prohibit activity)
  • Bilateral location
  • No aggravation by routine physical activity
• D- Both of the following
  
  • No nausea or vomiting
  • Either photophobia or phonophobia but not both together.

Question 6

What is the main difference between children and adults with regards to the symptoms of migraines?

Answer 6

In children, attacks may be shorter-lasting, headache is more commonly bilateral, and gastrointestinal disturbance is more prominent.

Question 7

Which one of the following features of migraine is more common in children?

Answer 7

Gastrointestinal disturbance

Question 8

How does migraine in children differ from adults?

Answer 8

• Usually doesn’t have aura
• It is shorter-lasting
• Headache is more commonly bilateral
• GI distrubances are more prominent