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.
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
- 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
- Motor signs
Complete Diagnostic Approach
Shown below is an algorithm summarizing the diagnosis of [[Headache]] according the the [...] guidelines.
Shown below is an algorithm summarizing the diagnosis of [[Headache]] according the the [...] guidelines.
| A01 | |||||||||||||||||||||||||||||||||
| B01 | B02 | ||||||||||||||||||||||||||||||||
| C01 | CO2 | ||||||||||||||||||||||||||||||||
| C01 | CO2 | ||||||||||||||||||||||||||||||||
| C01 | CO2 | ||||||||||||||||||||||||||||||||
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, diarrhoea
- 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