Headache in Pediatrics

Pain sensitive structures in Head Intracranial venous sinuses Parts of duras in base of the brain Proximal parts of major cerebral arteries Eyes,Ears,nose and sinuses Cranial nerves :II,III,V,X and first three cervisal nerves. Periosteum Muscles,Subcutaneous tissue and skin

Patterns of Headache in pediatrics Acute Acute Recurrent (Migraine-Tension-Epilepsy-...) Chronic progressive (SOL-HydrocephalusMeningitis-Brain Abcess) Chronic nonprogressive History>4mo-15 attack in mo-Each attack >4 h

Indications of Imaging Alteration of consciousness Absence of family history of migraine Abnormal neurological findings on examination Most severe in awakening, awaken from the sleep Gait abnormalities Chronic progressive pattern Progressive vomiting Seizures Headache exacerbate with cough Headache in children less than 6 yrs

Migraine Severe Duration 1-3 h(Up to 3 days) May be unilateral Pallor-Nausea-Aversion to light-sound and smells. Visual Aura(15-30 min beforevheadache) Always Family history is positive Aura like blurred vision-Scotoma(less common in pediatrics)

Tension Headache A dull and less severe than migraine. Continuous(many days) Disappear on holidays Underlying depression and anxiety is common More common near adolescence. Does not interfere with daily activities.

Raised ICT Progressive(severity and frequency) Wake the child from sleep. Vomitting,blurred vision,Seizure,Leg weekness

Raised ICT Pseudotumor cerebri Tumors Abcess ICH Brain Edema

Papilledema

Papilledema

Keypoints in headache In an acute onset headache specially with fever R/O the meningitis. In recurrent headaches, take the BP Carefull fundus examination Look for 6th nerve palsy,cerebellar signs Pain from supratentorial structures is reffered to the anterior 2/3 of the head and from infratentorial structures to vertex and back of the head.

Treatment Migraine: Biobehavioral Acute therapy(Analgesic-Thriptanes-Anti emetics) Prophylaxy(TCAs-Ciproheptadine-AEDs-B-Blockers-Ca channel blockers-Serotonine uptake inhibitors)