Pediatric headache

Question 1

Headache history and PE with special attention to

Answer 1

intracranial infection or space-occupying lesion

PATTERN is key

Question 2

PE components headache

Answer 2

vitals- HTN 
head circumference- hydrocephaly, macrocephaly 
ht/wt trajectory 
bruit, sinusitis, TMJ
visual fields- lesion 
fundoscopic- papilledema, bulging disc

Question 3

Three types of headaches

Answer 3

• migraine
• tension
• cluster

Question 4

Most common type of headache

Answer 4

migraine

Question 5

Migraine features

Answer 5

n/v/abdominal pain, desire to sleep
autonomic: photophobia, n/v
children, duration may be one hour, headache may be bilateral

if occipital- organic cause, further investigation

Question 6

Migraine diagnostics

Answer 6

4-72 hours
unilateral 
mod severe pain 
interfere activity 
vascular- pounding 
pulsating 

with or w/o aura (SEE UP TO DATE FOR THIS)

Question 7

Worrisome findings in headaches

Answer 7

• hydrocephalus
• cranial infections- meningitis encephalitis
• trauma
• neoplasms
• vascular disorders

Question 8

Tension characteritics

Answer 8

• bilateral
• tightness anywhere
• nonthrobbing
• mild to moderate
• 30 mins to several days
• may have photophobia but
• NO N/V
• NOT AGGRAVATED BY PHYSICAL ACTIVITY

Question 9

Cluster headaches characteristics

Answer 9

-ALWAYS unilateral
-USUALLY frontal-periorbital
-severe
-

Question 10

Neuroimaging

Answer 10

most children do not need, if no neurologic abdnormalities or exam or history do not need

Question 11

Migraine management in children

Answer 11

• Triptans (off label)
• Suma and Zolmi (strongest in ped) NASAL
• but start with oral (children do not like nasal)

Question 12

NSAID/acetaminophen

Answer 12

early admin is effective, avoid aspirin

Question 13

Naproxen

Answer 13

children >12

Question 14

Prophylactic

Answer 14

Periactin (cyproheptadine) - anticholinergic CCB properties -weight gain
Propanolol
Amitriptyline- TCA