Headache resident survival guide (pediatrics)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Synonyms and keywords: Headache in kids, Pedicatic headache, approach to headache in children

Headache resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Classification

According to the ICHD- 3 (The International Classification of Headache Disorders 3rd edition) headache in children can be classified into 2 types based on the origin of the headache into Primary and Secondary headache

Primary headache is due a primary brain pathology they are mostly benign in nature.

• Migrane
• Tension Headache
• Cluster Headache

Secondary headache is due to any other underlying conditions:

• Meningitis
• Brain abcess
• Subdural Hematoma
• Encepahlitis
• Sinusitis
• Idiopathic intracranial hypertension
• Hydrocephalus

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Brain tumor
• Subdural Hematoma
• Meningitis
• Encephalitis
• Ventriculoperitoneal shunt
• Brain abscess
• Cerebral aneurysm
• Increased intracranial pressure

Common Causes

• Rhinitis
• Head trauma
• Migraine
• Tension Headache.
• Trigeminal autonomic Cephalalgia (Cluster Headache).

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention. The initial rapid evaluation is based on the guidelines:

Signs and symptom of a child with brain tumor. These children will need urgent CNS imaging and referral to a Child Neurologist.

• Headache Characteristics:
  • New persistant headache especially if for more than 4 weeks.
  • Change in nature of headache in previously diagnosed headache in children.
  • Symptoms like holding the head in children of age less than 4 years .
• Persistent nausea and vomiting on waking up especially if going on for more than 2 weeks.
• Eye examination
  • Papilloedema
  • Optic atrophy
  • New onset nystagmus
  • Proptosis
  • Visual field reduction
  • New onset paralytic non-comitant squint
  • Abnormal fundoscopy
• CNS Examination
• Nuchal rigidity
  • Motor signs
    • A regression in motor skills
    • Focal motor weakness
    • Abnormal gait and/or coordination (unless local cause)
    • Bell’s palsy (isolated lower motor facial palsy) with no improvement within 4 weeks
    • Dysphagia (unless local cause)
    • In infants - Change in hand or foot preference
    • Loss of learnt skills
  • Lethargy
  • Seizure
  • Atypical aura- basilar type, hemiplegic.
  • Cluster headache in Child
  • Brief cough headache in a child

Complete Diagnostic Approach

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Primary Headache

Secondary Headache

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Treatment

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Do's

• The content in this section is in bullet points.

Don'ts

• Failure to reassess a child with migraine or tension headache when the headache character changes
• Attributing persistent nausea and vomiting to an infective cause in the absence of corroborative findings, eg, contact with similar illness, pyrexia, diarrhea
• Failure to fully assess vision in a young or uncooperative child
• ▶Failure of communication between community optometry and primary and secondary care
• Attributing abnormal balance or gait to middle ear disease in the absence of corroborative findings
• Failure to identify swallowing difficulties as the cause of recurrent chest infections or “chestiness”
• Attributing impaired growth with vomiting to gastrointestinal disease in the absence of corroborative findings
• Failure to consider diabetes insipidus in children with polyuria and polydipsia

References

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