Headache history and PE with special attention to
intracranial infection or space-occupying lesion
PATTERN is key
PE components headache
vitals- HTN head circumference- hydrocephaly, macrocephaly ht/wt trajectory bruit, sinusitis, TMJ visual fields- lesion fundoscopic- papilledema, bulging disc
Three types of headaches
- migraine
- tension
- cluster
Most common type of headache
migraine
Migraine features
n/v/abdominal pain, desire to sleep
autonomic: photophobia, n/v
children, duration may be one hour, headache may be bilateral
if occipital- organic cause, further investigation
Migraine diagnostics
4-72 hours unilateral mod severe pain interfere activity vascular- pounding pulsating
with or w/o aura (SEE UP TO DATE FOR THIS)
Worrisome findings in headaches
- hydrocephalus
- cranial infections- meningitis encephalitis
- trauma
- neoplasms
- vascular disorders
Tension characteritics
- bilateral
- tightness anywhere
- nonthrobbing
- mild to moderate
- 30 mins to several days
- may have photophobia but
- NO N/V
- NOT AGGRAVATED BY PHYSICAL ACTIVITY
Cluster headaches characteristics
-ALWAYS unilateral
-USUALLY frontal-periorbital
-severe
-
Neuroimaging
most children do not need, if no neurologic abdnormalities or exam or history do not need
Migraine management in children
- Triptans (off label)
- Suma and Zolmi (strongest in ped) NASAL
- but start with oral (children do not like nasal)
NSAID/acetaminophen
early admin is effective, avoid aspirin
Naproxen
children >12
Prophylactic
Periactin (cyproheptadine) - anticholinergic CCB properties -weight gain
Propanolol
Amitriptyline- TCA
