Childhood headaches §Dr Adi Aran §Neuropediatric Unit §SZMC.

Slides:



Advertisements
Similar presentations
Headache.
Advertisements

Headache Lawrence Pike.
بسم الله الرحمن الرحيم Headache and facial pain Dr.Hayder Kadhum H. FICM NEUR. /Fellow Ship-Luvan university KUFA COLLEGE OF MEDICINE.
Headache Guideline Cumbria
HOW CAN I BE SURE THIS IS A STROKE ? - DR. INDIRA NATARAJAN LOCUM CONSULTANT LOCUM CONSULTANT UNIVERSITY HOSPITAL OF NORTH STAFFRODSHIRE UNIVERSITY HOSPITAL.
Headaches - In Primary Care Dr M Banerjee GP Registrar Tadworth.
Morning Report: Tuesday, March 6th. AKA: Pseudotumor Cerebri.
Dr. Zhao TCM Help Migraine Remedy: Acupuncture and Herbs Time: 1-2 weeks the Migraine is away. Cost: $380CAD Success Rate: >85%. Offer Herbs for prevention.
Headache Catriona Gribbin.
بسم الله الرحمن الرحيم كل عام وانتم بخير Headache and facial pain Dr.Hayder Kadhum H. FICM NEUR. /Fellow Ship-Luvan university KUFA COLLEGE OF MEDICINE.
Jeffrey S Royce MD, FAAFP, FAHS.  Age 3 3-8%  Age %  Age %
2008. Diagnostic criteria  At least 10 episodes fulfilling following criteria  Headache lasting 30 mins to 7 days  Has 2 at least 2 of the following.
Headache  Headache is one of the commonest neurological complain reported at neurology clinic 
Department of Neurology, SJUH Acute headache Problems that can not wait until the post take ward round
Approach to Headaches AIMGP Seminar October 2004 Manaf Qahtani.
Study Group Laura Maidment.  Primary headaches 1) Migraine 2) Tension –type headaches 3) Cluster headaches 4) Other primary headaches  Secondary headaches.
跳转到第一页 Headache Zheng Dongming. 跳转到第一页 n The most common symptom in clinic n the causes are myriad. 1.intracranial disease 2.extracranial disease 3.functional.
Presentation by: Leshawnda Willingham & Gloria Melchor Presented for Dr. Ryan Bellacov, chiropractor in West Linn, OR.
Headaches. CONTINUITY CLINIC Objectives Recognize and differentiate the elements of history and physical findings associated with the following headache.
Dr. amal Alkhotani Frcpc neurology, epilepsy
Headaches By: Gabie Gomez. Why does my head hurt ????? Headaches are a neurological complaint that can be insignificant or prodromal. The exact mechanism.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Diagnosis and management of primary headache
Online Module: Pseudotumor Cerebri
Headache Dr. Mansour Al Moallem.
Neurology Lecture 4a Headaches.
Migraine Headaches Migraine Severe, throbbing, vascular headache
Rational brain imaging in primary care
Headaches in children Elba I. Mehta MD, FAAP
BALANCING LIFE’S ISSUES, INC. Learning About Headaches.
Headache. Agenda History Physical Classification Management.
Migraine Headaches Migraine – Severe, throbbing, vascular headache – Recurrent unilateral head pain – Combined with neurologic and GI disturbances.
HERPES SIMPLEX ENCEPHALITIS ENCEPHALITIS M.RASOOLINEJAD, MD DEPARTMENT OF INFECTIOUS DISEASE TEHRAN UNIVERCITY OF MEDICAL SCIENCE.
Headache in Children. Pain-sensitive structures in the head Intracranial Structures Venous sinuses and afferent veins Arteries of the dura mater and pia-arachnoid.
ELS PEDS ! MCH protocols and peds exam for adult trainees.
Classification of Headache
Migrainous Vertigo Dr Mark Lewis MY NsC. Migrainous Vertigo Outline Case studies (Migraine) Terminology Pathophysiology Epidemiology Clinical features.
 Headache is the 4th most common symptom of outpatient visits.
جامعة الكوفه مركز تطوير التدريس والتدريب الجامعي Tention Headache اعداد د. محمد راضي رديف بورد طب جمله عصبيه كلية الطب – جامعة الكوفه 2015 م.
Dublin November 13 th 2011 By Dr. Edward O’Sullivan 13-Nov
Headache in General Practice 21 st October Headache ( To differentiate secondary from primary.
Headache in Pediatrics
Approach to the Patient with Head and Facial Pain Neurology
Headaches in Childhood Maura B. Price MD FAAP FRCPC February 2010
 Headache DDX Migraine Tension headache ↑ ICP.
Headache Headache affects 75% of population per year (45 million people) and 25% of Neurology OP referrals Daily headache affects 4% of population On.
원더스 참고자료 두통. 1 차성 두통에 대한 자료 2 차성 두통에 대한 자료.
Approach to patient with Headache. Introduction pain cranium faceneck Headache.
Headache Holly Cronau, MD Associate Professor of Family Medicine
Yasser Alhazzani Mohammad khan Zeyad alhozaimy
Headache. Migraine Migraine is an episodic primary headache disorder. Symptoms typically last 4 to 72 h and may be severe. Pain is often unilateral, throbbing,
Dr. Margaret Gluszynski
Headaches Jo Swallow ST1s May 2009.
Approach to patient with headache
Dr. Saad Al Asiri FACIAL PAIN & HEADACHE MD, DLO, KSF, Rhino
Headache.
Dr. Margaret Gluszynski
Headache.
Headache Dr shinisha paul.
HEADACHE.
Migraine Headaches Migraine Severe, throbbing, vascular headache
Headaches Feedback from BASH 3rd Nov 2017.
HEADACHE SYNDROMES Dr. M. A. Sofi MD; FRCP; FRCPEdin; FRCSEdin Al Maarefa College of Science & Technology.
Dr Mohamad Shehadeh Agha MD MRCP(UK)
Headaches in Children بسم‌الله الرحمن الرحيم M. Mohammadi MD
Headache.
Approach to Headache Dr. Dua’a Hiasat. Family Medicine Specialist.
Headache Lawrence Pike.
Dr sadik al ghazawi Associated professer Neurologist Mrcp,frcp uk
Dr sadik al ghazawi Associated professer Neurologist Mrcp,frcp uk
Presentation transcript:

Childhood headaches §Dr Adi Aran §Neuropediatric Unit §SZMC

Childhood Headaches §-Occur in approx. 35% of children by 7 years of age and 50% of children by 15. §Frequent headache occure in approx. 2.5 % of children by 7 years of age and 15% of children by 15. §-Parents are looking for reassurance that the headache is not due to a serious cause

Where the pain coming from? §Not - the brain, most of the meninges overlying the brain and the bony skull §Pain referred to the head can arise from: l Extra/Intra-cranial arteries and veins l Cranial or spinal nerves l Basal meninges l Cranial or cervical muscles l Extracranial structures (sinuses, teeth, etc.)

Pathogenesis of pain- cont. §Cranial circ. & supratentorial structures exhibit pain via the trigeminal nerve §Posterior fossa structures exhibit pain via the first three cranial nerves, the vagus nerve and the glossopharyngeal nerve

Categorize the Headache §Acute §Acute recurrent §Chronic non-progressive §Chronic progressive §Mixed time severity time severity time severity time severity time severity

An Isolated, Acute Headache §Causes: l Viral illness l Sinusitis l Migraine l Dental abscess l Intracranial hemorrhage w/ or w/o trauma l Hypertension l Meningitis  All of the children with serious underline condition had one or more objective finding on neurological examination

Other common Headaches §Migraine Headache (Acute recurrent) §Stress-Related (Tension) Headache (Chronic non progressive) §Headache Due to Increased ICP (Chronic progressive) §Cluster Headache (Acute recurrent) §Migraine superimposed on Stress-Related (Tension) Headache (mixed)

As Usual-Take a Good History §Characteristics of a typical episode l Location l Intensity of pain l Duration l Frequency l Preceding aura? l Associated symptoms (GI, visual, neuro)

Other Good Questions §What makes the headache better or worse? §When do the headaches occur? §Any known triggers or stressors? l School, lack of sleep, problems in the family §Any medications? §Any pertinent family history? l Allergies, migraines

A Focused Physical Exam §Growth Parameters §Blood Pressure §Head Circumference §Head and neck palpation §Fundoscopic Exam §Complete Neurologic Examination §Skin §More than 98% of children with brain tumors have objective neurologic findings

Neuroimaging – pros and cons §Pros – some times it is the only thing that will assist the parents (and the doctor) to sleep at night. §Cons – it is not cost- effective - the vast majority of children in Israel will undergo CT scan. - The estimates of lifetime attributable risk for fatal cancer from one current generation CT scan range from 1 per 2000 scans for young infants to 1 per 5000for those 10 years old. - Low doses of inoising radiation in infancy may adversely affect cognitive abilities

Indications For A Scan §Any neurologic abnormality §Signs of increased intracranial pressure l Papilledema l HA’s or vomiting at night or awakening. l Pain is worsened with sneezing, coughing, etc. l Chronic progressive pattern §Worst headache of life §Presence of neurocutaneus syndrome §Presence of V-P shunt §Age younger than three years §Unvarying location of headaches

Is an LP indiciated? §After brain imaging l Herniation is bad! §If pseudotumor cerebri is suspected l Elevated opening pressure l Partial relief in HA

Migraines in Childhood §Most common cause of intermittent HA’s in childhood §The prevalence in children under 7 years old is higher in boys and after 11 years is higher in girls. §Diagnosis is based on classical symptoms

Criteria for Diagnosis of pediatric migraine without aura (ICHD, IHS – 2004) A. Five or more attacks fulfilling features B-D. B. Headache attack lasting 1 to 72 hours. C. Episodes are accompanied by at least one of the following: l Photophobia and phonophobia l Abdominal pain, nausea or vomiting D. Episodes characterized by at least two of the following: l Bilateral or unilateral ( frontal / temporal) location l pulsatile pain l Moderate to severe intensity l Aggravated by routine physical activities Not a criteria: l Complete relief after rest l Family history of migraines

Potential Migraine Triggers §Emotional or Physiological Stress l Missing a meal, lack of sleep §Environmental Factors §Foods and Chemicals l Caffeine, chocolate, cheese, aspartame, etc. §Drugs l Histamine-2 blockers, OCP’s, Ritalin.....

Migraine with Aura (Classic) §Precedes the HA onset and lasts 5-20 minutes §What’s an aura? l Flashing or colored lights, dots, zigzags l Scotomas l Distortions of size

Complicated Migraine §Migraine associated with a transient neurologic abnormality l Hemiparesis, visual field defects, CN palsy Most common cause of CN-III palsy in children l “Basilar” migraine Vertigo, ataxia, tinnitus, etc. More common in adolescent females

Migraine Equivalent Episodes §Episodes that do not necessarily include headache, but believed to be of a migrainous etiology l Confusional migraine l Benign paroxysmal vertigo l Alice in Wonderland Syndrome l Abdominal migraine

Stress-Related Headache §Also known as a tension headache §Pain is characteristically: l A “band-like” distribution l Generally, a constant ache w/ some throbbing l Usually constant §More common in older girls

Similar to Common Migraine §Stress-Related l More related to fatigue, but do not readily respond to sleep l Minimal nausea l Usually involve the whole head §Common Migraine l Respond to sleeping l Nausea and vomiting are characteristic l Usually unilateral

Increased Intracranial Pressure §Expanding lesion may cause progressive worsening of headaches l Direct expansion l Obstruction of CSF flow §Headache is worse at night or immediately after waking

Other Cues That ICP is Elevated §Headache is worsened by maneuvers which raise venous pressure l Bending over, coughing, straining §Transient obscurations of vision §Vomiting may provide temporary relief

Look for Papilledema §It may not be seen in every instance of elevated ICP. §If seen, a Head CT or MRI is indicated prior to attempting an LP Fig from Zitelli: Atlas of Pediatric Physical Diagnosis, St. Louis, 1997, Mosby-Wolfe

Causes of increased ICP §Neoplasm l Mass-effect l Resulting in obstructive hydrocephalus §Hydrocephalus l Independent of or resulting from neoplasm §Pseudotumor cerebri §Subdural hemorrhage

Brain Tumors in Children §Etiology of headache §Headaches occur in 60-65% of patients w/ brain tumors §Symptoms are: l Worse on waking l May improve with vomiting Contemporary Pediatrics, 16:11 November 1999, p86.

Cluster Headaches §Occurs rarely during adolescence l Recurrent, extreme, non-throbbing pain l Usually around an eye l Eye watering l Facial Flushing

Other Headaches to Consider §Refractive errors l Related to reading or working at a computer l Providing eye rest improves symptom §Ictal or postictal phenomenon l Poorly-controlled seizure d/o l Head-grabbing in a developmentally delayed patient?

Management and Therapy for Recurrent Headaches

Patient and Family Education §Reassurance that the etiology is benign §Explain the diagnosis and underlying cause §Help the patient recognize situations that precipitate and exacerbate headaches

Acute Migraine Management §Sleep-effective in most attacks l Sedatives may be helpful §Simple analgesics l Less efficacious once an attack is established l Neurophen is more effective than Acamol / Optalgin §Sumatriptan (Imitrex) §Cafergot / Temigran (DHE) §Migralev

Sumatriptan (Imitrex) §A selective 5-HT agonist ( Relert, Naramig, Rizalt ) §Effective, but expensive l Dosage recommendations in children have not been fully established §Comes in a variety of preparations l PO, Intranasal

Prophylaxis Against Migraines §Identification of precipitating factors and subsequently avoiding them l Food diary, family dynamics, school problems §Pharmacologic Therapy §Behavioral therapy l Biofeedback l Relaxation therapy l Hypnosis

One Form of Relaxation Therapy

Another Form of Relaxation Therapy

When to Use Pharmacotherapy §When the frequency of headaches interferes with the child’s daily functioning l Missing school l Nutritional concerns §Most regimens are based on adult practice or anecdotal reports

Prophylactic Agents §Propranolol (deralin) –1-4 mg/kg divided TID §Clonirit –25 mcg x 2/d §Amitryptiline (Elavil) –Can be used for children 6 or older §Topamax

Tension Headache Treatment §Acute attacks l Simple analgesia, rest, and removal of stressors is very effective §Chronic occurrence l Identification of stressful situations l Relaxation techniques, massage therapy and acupuncture

“Analgesic” Abuse Headache §AKA “Drug-induced Refractory” headache §A consequence of frequent analgesic use l Do not occur only with opiates l Ergotamine, NSAIDS and acetaminophen have also been cited as being causative §Treatment- Educating the patient and family on how to alter pattern of analgesic use

A Little Review on Headaches §Take a thorough history §Categorize the headache §Perform a physical exam l Any neurological abnormality or papilledema? §Head Imaging? LP? §Acute Treatment §Prophylaxis/Avoidance