Headaches and Back pain

Question 1

What are the two types of primary headaches in children

Answer 1

Migraine and tension

Question 2

Bandlike sensation around the head - neck and shoulder pain, lasts for days

Answer 2

tension headache

Question 3

Headache worse in AM and improves throughout day - aggravated by coughing/sneezing

Answer 3

Secondary headache underlying CNS pathology (most likely SOL)

Question 4

What are the IHS criteria for migraines in children

Answer 4

Five or more HA that:
-Last 1-48 hours

Have at least 2 of:

• Bilateral or unilateral
• Pulsating quality
• moderate to severe intensity
• Aggravated by physical activity

Have at least 1 of:

• Nausea and/or vomiting
• Photophobia and/or phonophobia

Question 5

Migraine variants make up how many pediatric migraines? Which is MC?

Answer 5

24.3% of migraines are variants

Basilar type (6.3%)

Question 6

True or false; both hydrocephalus and medications can cause both acute or chronic-progressive HA’s

Answer 6

true

Question 7

True or false; Sinus tenderness, thryomegaly, nuchal rigidity and head circumference are all possible findings in a head/neck exam of HA child

Answer 7

True

Question 8

Neurofibromatosis and tuberous sclerosis both show signs where? What is the fancy name for these?

Answer 8

On the skin

Neurocutaneous syndrome

Question 9

When would CT/MRI be considered with a pediatric HA?

Answer 9

Chronic progressive HA pattern OR Abnormal findings in the neurologic exam (be detailed with neurologic exam!!!)

Question 10

True or false; lumbar puncture, blood cultures, sinus radiography, psychologic eval are all possible secondary tests to consider with pediatric HAs?

Answer 10

true

Question 11

When is a neurological consult indicated in pediatric HAs

Answer 11

Acute HA w/ focal neurologic symptoms/signs

Chronic-progressive HA

Question 12

Once you’ve established that a HA is of primary origin what is some advice to give parent of patient

Answer 12

quiet dark room
sleep
manage stress: relax techniques, develop schedule
diet (avoid triggers)

Chiropractic!`

Question 13

What is Scheuermann’s disease

Answer 13

Exaggerated kyphosis in mid-thoracic

Caused by anterior vertebral body wedging of 3 or more adjacent vertebrae

Question 14

True or false; on top of adjustments and soft tissue work stretching hamstrings and strengthening abdominals are viable management options for Scheuermann’s disease

Answer 14

true

Question 15

If a child has specific point tenderness in the lumbar region what should one of your DDx be?

Answer 15

Facet tropism

Question 16

True or false; patients with facet tropism responds well to side posture adjustments

Answer 16

false

Question 17

True or false; Spondylolisthesis is commonly asymptomatic in children

Answer 17

true

Question 18

Child 4 weeks
Fever present 
Antalgic posture 
Neurologic abnormality 
Limitation of motion due to pain 

These are all what?

Answer 18

Warning signs in pediatric back pain

Question 19

True or false; majority of childhood headaches are migraines

Answer 19

true