Headache

Question 1

Which intracranial structures are not sensitive to pain?

Answer 1

brain
ependymal lining
choroid plexus
much of dura and pia-arachnoid over hemispheres

Question 2

What are the most pain sensitive intracranial structures?

Answer 2

• proximal portions of the large cerebral arteries at the base of the brain
• venous sinuses
• large cerebral veins

Question 3

What are the most common causes of headache in peds?

Answer 3

URTI
Migraine
Post-traumatic
Tension-type

Question 4

What are Vascular causes of of headache?

Answer 4

• febrile illness
• migraine
• systemic hypertension
• hypoxia
• caffeine withdrawal Wha

Question 5

What are the Muscular causes of headache?

Answer 5

Tension

Question 6

What are the Inflammatory causes of headache?

Answer 6

• intracranial infection (meningitis, encephalitis, brain abscess)
• pharyngitis
• URTI
• dental infection
• sinus infection
• retroorbital cellulitis/abscess

Question 7

What are the traction/compression causes of headache?

Answer 7

• brain tumour
• intracranial hemorrhage
• increased ICP
• brain abscess
• LP
• Arterial dissection

Question 8

What are the symptoms of arterial dissection? (vertebral)

Answer 8

may have headache for hours-days before developing neuro deficits
- neck pain and severe occipital headache that ofcurs after minor trauma to the neck, followed by onset of ataxia, nystagmus and unliateral weakness

Question 9

What is the classic presentation of pseudotumour cerebri?

Answer 9

adolescent, overweight female
severe, unrelenting headache that may gradually worsen
**newly blurry vision

Question 10

What are the characteristic findings on history of brain tumour?

Answer 10

• Nocturnal headache or pain onn arising in the morning
• worsening over time
• associated with vomiting, especially if vomiting progressively worse
• Behavioural changes
• polydipsia/polyuria (craniopharyngioma)
• History of probable neurologic deficits (ataxia, clumsiness, blurred vision or diplopia)

Question 11

What are the criteria for diagnosis of migraine?

Answer 11

A- 5 attack that fulfills criteria B-C
B- Headache lasting 1-72hrs
C- Two of the following features:
- Unilateral or bilateral Frontotemporal headache
- Pulsating
- Increase by or causing avoidance of routine physical activity
- Moderate to severe.
D- One of the following:
- Nausea and /or Vomiting
- Photphobia and phonophobia
E- Not attributed to any other cause

Question 12

Subtypes of migraines (not just with aura)

Answer 12

• Abdominal migraine (cyclic vomiting)
• Hemiplegic migraine
• Dysphasic
• Migraine with brainstem aura (basilar-type migraine)
• Syndrome of transient headache and neurologic deficits with CSF lymphocytosis
• Childhood periodic syndromes