Headache resident survival guide (pediatrics)

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

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

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.

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

Complete Diagnostic Approach

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

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|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 -

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 }}}

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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