Headache resident survival guide (pediatrics): Difference between revisions

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{{familytree| | C03 | | C01 | | C02 | | | C09 | | C08 | | C04 | | C05 | | | C06 | | C07 | | | | | | | | ||C03=Migrane|C01=Tension Headache|C02=Cluster Headache|C09=Neoplasm|C08=Sinusitis|C04=Bacterial Meningitis|C05=CO Poisoning|C06=Intracranial Hemorrhage|C07=Cerebral Abscess}}  
{{familytree| | C03 | | C01 | | C02 | | | C09 | | C08 | | C04 | | C05 | | | C06 | | C07 | | | | | | | | ||C03=Migrane|C01=Tension Headache|C02=Cluster Headache|C09=Neoplasm|C08=Sinusitis|C04=Bacterial Meningitis|C05=CO Poisoning|C06=Intracranial Hemorrhage|C07=Cerebral Abscess}}  
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{{familytree| | |!| | | |!| | | |!| | | | |!| | | |!| | | |!| | | |!| | | | |!| | | |!| | | | | | | | | | }}
{{familytree| | D01 | | D02 | | D03 | | | D04 | | D05 | | D06 | | D07 | | | D08 | | D09 | | | | | | | | | | | | | | | | | | }}
{{familytree| | Migraine clinical features:
*Onset- Starts in first decade of life, gradual in onset, crescendo pattern.
*Intensity- Moderate to severe.
*Presentation- Bilateral in young children, unilateral in adolescents.
*Frequency- 2-4 times/month
*Duration- 2-3 hour in young children, 48-72 hour in adolescent.
*Character- Throbbing pulsating
*Aggravating factors- bright light, noise, strong food odour.
*Alleviating factors- Dark room, cool compress, sleep.
*Family history is a strong indicator. | | D02 | | D03 | | | D04 | | D05 | | D06 | | D07 | | | D08 | | D09 | | | | | | | | | | | | | | | | | | }}
|C03=Migrane|C01=Tension Headache|C02=Cluster Headache}}
|C03=Migrane|C01=Tension Headache|C02=Cluster Headache}}
{{familytree| | |!| | | | | | | | | | | | }}
{{familytree| | |!| | | | | | | | | | | | }}
{{familytree|,|-|+|-|-|-|-|-|-|-| | | | | }}
{{familytree| |,|+|-|-|V|-|-|-|V|-|-|-|.}}
{{familytree|!| | |!| | |!| | |!| | | | | }}
{{familytree| |!| | | |!| | | |!| | | |!| }}
{{familytree|E01| |E02| |E03| |E04| | | | | | | | }}
{{familytree| Migraine without aura criteria:
At least 5 attacks fulfilling A to C:
A. 4-72 hour duration of the headache.
B. 2 of the following 4 -
# Unilateral location
# Pulsating character of pain
# Moderate to severe intensity.
# Aggravated by physical activity
C. Headache associated with nausea, vomiting, photophobia and phonophobia.
| | Migraine with typical Aura.
At least 2 attacks fulfilling criteria A to B:
A. Aura can be visual, sensory, speech each fully reversible but no motor, brain stem or retinal symptoms.
B. At least 2 of the 4:
# Aura symptom spreads gradually over 5 or more minutes.
# Duration- Aura symptoms last 5-60 minutes.
# At least one aura symptom is unilateral.
# Aura is followed within 60 minutes by headache. | | Migraine with Brain stem Aura:
At least 2 attacks fulfilling criteria A to C.
A. Aura consisting of visual, sensory, and or speech each fully reversible but no motor or retinal symptoms.
B. At least 2 of the following brain stem symptoms
# Dysarthria, vertigo, tinnitus, diplopia, ataxia, decrease level of consciousness.
C. Atleast 2 of the following 4
# Atleast 1 aura symptom spreads over 5 minutes and 2 or more occur in succession.
# Each individual aura lasts 5-60 minutes.
# Atleast 1 aura is unilateral.
# Aura is accompanied or followed within 60 minutes by headache.
| | Vesticular Migrane with vertigo:
*At least 5 episodes fulfiling criteria A, B and C.
A. Current or past history of migrane with aura or migrane without aura.
B. Vestibular symptoms of moderate to severe intensity lasting 5 minutes to 72 hour
C. Atleast 50% of episodes are associated with atleast 1 of the following
# Headache with atleast 2 of the following 4 characteristics.
  Unilateral location, pulsating quality, moderate to severe intensity and aggravation by routine physical activity.
# Photophobia and phonophobia.
# Visual aura | | | | | | | | }}
{{familytree| | | | | | | | | | | | | | | }}
{{familytree| | | | | | | | | | | | | | | }}
{{familytree| | | | | | | | | | | | | | | }}
{{familytree| | | | | | | | | | | | | | | }}

Revision as of 09:27, 14 August 2020


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.

Secondary headache is due to any other underlying conditions:

Causes

Life Threatening Causes

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

Common Causes

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.

Complete Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of [[Headache]] according to the [...] guidelines.

}}

|C03=Migrane|C01=Tension Headache|C02=Cluster Headache}}


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Headache
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Primary Headache
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Secondary Headache
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Migrane
 
Tension Headache
 
Cluster Headache
 
 
Neoplasm
 
Sinusitis
 
Bacterial Meningitis
 
CO Poisoning
 
 
Intracranial Hemorrhage
 
Cerebral Abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ Migraine clinical features:
  • Onset- Starts in first decade of life, gradual in onset, crescendo pattern.
  • Intensity- Moderate to severe.
  • Presentation- Bilateral in young children, unilateral in adolescents.
  • Frequency- 2-4 times/month
  • Duration- 2-3 hour in young children, 48-72 hour in adolescent.
  • Character- Throbbing pulsating
  • Aggravating factors- bright light, noise, strong food odour.
  • Alleviating factors- Dark room, cool compress, sleep.
  • Family history is a strong indicator. }}}
 
{{{ D02 }}}
 
{{{ D03 }}}
 
 
{{{ D04 }}}
 
{{{ D05 }}}
 
{{{ D06 }}}
 
{{{ D07 }}}
 
 
{{{ D08 }}}
 
{{{ D09 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ Migraine without aura criteria:

At least 5 attacks fulfilling A to C: A. 4-72 hour duration of the headache. B. 2 of the following 4 -

  1. Unilateral location
  2. Pulsating character of pain
  3. Moderate to severe intensity.
  4. Aggravated by physical activity

C. Headache associated with nausea, vomiting, photophobia and phonophobia.

}}}
 
{{{ Migraine with typical Aura.

At least 2 attacks fulfilling criteria A to B: A. Aura can be visual, sensory, speech each fully reversible but no motor, brain stem or retinal symptoms. B. At least 2 of the 4:

  1. Aura symptom spreads gradually over 5 or more minutes.
  2. Duration- Aura symptoms last 5-60 minutes.
  3. At least one aura symptom is unilateral.
  4. Aura is followed within 60 minutes by headache. }}}
 
{{{ Migraine with Brain stem Aura:

At least 2 attacks fulfilling criteria A to C. A. Aura consisting of visual, sensory, and or speech each fully reversible but no motor or retinal symptoms. B. At least 2 of the following brain stem symptoms

  1. Dysarthria, vertigo, tinnitus, diplopia, ataxia, decrease level of consciousness.

C. Atleast 2 of the following 4

  1. Atleast 1 aura symptom spreads over 5 minutes and 2 or more occur in succession.
  2. Each individual aura lasts 5-60 minutes.
  3. Atleast 1 aura is unilateral.
  4. Aura is accompanied or followed within 60 minutes by headache.
}}}
 
{{{ Vesticular Migrane with vertigo:
  • At least 5 episodes fulfiling criteria A, B and C.

A. Current or past history of migrane with aura or migrane without aura. B. Vestibular symptoms of moderate to severe intensity lasting 5 minutes to 72 hour C. Atleast 50% of episodes are associated with atleast 1 of the following

  1. Headache with atleast 2 of the following 4 characteristics.
 Unilateral location, pulsating quality, moderate to severe intensity and aggravation by routine physical activity. 
  1. Photophobia and phonophobia.
  2. Visual aura }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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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