1. Headache in Pediatrics

2. 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

3. 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

5. 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

6. 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)

7. 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.

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

9. Raised ICT
Pseudotumor cerebri
Tumors
Abcess
ICH
Brain Edema

10. Papilledema

11. Papilledema

12. 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.

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