Headache. Agenda History Physical Classification Management.

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Presentation transcript:

Headache

Agenda History Physical Classification Management

History Chronicity –Duration –Frequency –Acute vs. chronic Location Severity Radiation Quality/character PMH Family History Medications Ameliorating or exacerbating factors Social History and effect on activity

Physical ABCs Vitals HEENT – fundoscopic exam CV Pulm MSK – reproducible (TMJ, occipital, etc.) Neuro Skin

Classification Primary Tension – bilateral tightness, intermittent and recurring Cluster – unilateral, frontal-periorbital Migraine – paroxysmal w/ autonomic symptoms, chronic and remitting Chronic daily headache Idiopathic intracranial hypertension Secondary Infection –Meningitis –Encephalitis –Abscess –Central venous thrombosis –Sinusitis –Pharyngitis –Otitis media Tumor Intracranial hemorrhage CO poisoning Hypertension

Management Neuro imaging not indicated for recurrent HA w/ normal neuro exam Consider CT for new onset migraine w/ normal exam MRI for HA associated w/ sleep, emesis, and/or abnormal exam inc. skin findings LP after imaging if concerned for infection or increased ICP

Management All headaches NSAIDs –Ibuprofen –Naproxen –Ketorolac Acetaminophen Amitriptyline Biofeedback Counseling Migraines Abortive –Antimemetics –Ergotamine –Triptans Prophylactic –Cyproheptadine –B blockers –Valproate + folate –Amitriptyline –Other AEDs

References Lewis DW, Dorbad D. The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache Sep;40(8): Lewis DWDorbad D Brazis, Paul, et al. Approach to the child with headache. Cruse, Robert. Classification of migraine in children. Cruse, Robert. Management of migraine headache in children. Cruse, Robert. Tension headache in children. King, Christopher. Emergent evaluation of headache in children.