Headache resident survival guide (pediatrics)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Synonyms and keywords: Headache in kids, Pedicatic headache, approach to headache in children

Headache resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Classification

According to the ICHD- 3 (The International Classification of Headache Disorders 3rd edition) headache in children can be classified into 2 types based on the origin of the headache into Primary and Secondary headache

Primary headache is due a primary brain pathology they are mostly benign in nature.

Secondary headache is due to any other underlying conditions:

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention. The initial rapid evaluation is based on the guidelines:

Signs and symptom of a child with brain tumor. These children will need urgent CNS imaging and referral to a Child Neurologist.

Complete Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of [[Headache]] according to the [...] guidelines.

}}

|C03=Migrane|C01=Tension Headache|C02=Cluster Headache}}


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Headache
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Primary Headache
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Secondary Headache
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Migrane
 
Tension Headache
 
Cluster Headache
 
 
Neoplasm
 
Sinusitis
 
Bacterial Meningitis
 
CO Poisoning
 
 
Intracranial Hemorrhage
 
Cerebral Abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ Migraine clinical features:

❑ Onset- Starts in first decade of life, gradual in onset, crescendo pattern. ❑ Intensity- Moderate to severe. ❑ Presentation- Bilateral in young children, unilateral in adolescents. ❑ Frequency- 2-4 times/month ❑ Duration- 2-3 hours in young children, 48-72 hours in the adolescent. ❑ Character- Throbbing pulsating ❑ Aggravating factors- bright light, noise, strong food odor. ❑ Alleviating factors- Darkroom, cool compress, sleep.

❑ Family history is a strong indicator. }}}
 
{{{ ❑ Duration - minutes to days, the variable can be all day (30 mins - 7 days)

❑ Alleviating factors- Tension headache decreases with sleep. Pain does not worsen with routine physical activity. Not associated with photophobia or phonophobia. ❑ Presentation- Episodic non-throbbing headache, constant pressure, bilateral pressing tightening in quality, mild to moderate intensity. Bilateral pressure tightness that waxes and wanes. ❑ Severity- Mild to moderate severity. ❑ Location - diffuse.


Criteria At least 10 episodes of headache fulfilling criteria A through C. Infrequent and frequent episodic subforms of TTH are distinguished as follows: Infrequent episodes - Headache occurring < 1 day /month on average <12 days per year. Frequent episode - Headache occurring on 1-14 days/ month on average for >3 months (>12 and <180 days/year). A. Headache lasting 30 min - 7 days B. 2 of the following 4

  1. Bilateral location, pressing/tightening (non - pulsating) quality. Mild or moderate intensity. Not aggravated by routine physical activity such as walking or climbing stairs.

C. No nausea or vomiting, no more than one of photophobia or phonophobia.


}}}
 
{{{ D03 }}}
 
 
{{{ D04 }}}
 
{{{ D05 }}}
 
{{{ D06 }}}
 
{{{ D07 }}}
 
 
{{{ D08 }}}
 
{{{ D09 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ Migraine without aura criteria:

At least 5 attacks fulfilling A to C: A. 4-72 hour duration of the headache. B. 2 of the following 4 -

  1. Unilateral location
  2. Pulsating character of pain
  3. Moderate to severe intensity.
  4. Aggravated by physical activity

C. Headache associated with nausea, vomiting, photophobia, and phonophobia.

}}}
 
{{{ Migraine with typical Aura.

At least 2 attacks fulfilling criteria A to B: A. Aura can be visual, sensory, speech each fully reversible but no motor, brain stem, or retinal symptoms. B. At least 2 of the 4:

  1. Aura symptom spreads gradually over 5 or more minutes.
  2. Duration- Aura symptoms last 5-60 minutes.
  3. At least one aura symptom is unilateral.
  4. Aura is followed within 60 minutes by headache. }}}
 
{{{ Migraine with Brain stem Aura:

At least 2 attacks fulfilling criteria A to C. A. Aura consisting of visual, sensory, and or speech each fully reversible but no motor or retinal symptoms. B. At least 2 of the following brain stem symptoms

  1. Dysarthria, vertigo, tinnitus, diplopia, ataxia, decreased level of consciousness.

C. At least 2 of the following 4

  1. At least 1 aura symptom spreads over 5 minutes and 2 or more occur in succession.
  2. Each individual aura lasts 5-60 minutes.
  3. At least 1 aura is unilateral.
  4. Aura is accompanied or followed within 60 minutes by headache.
}}}
 
{{{ Vesticular Migrane with vertigo:

At least 5 episodes fulfilling criteria A, B, and C. A. Current or past history of migraine with aura or migraine without aura. B. Vestibular symptoms of moderate to severe intensity lasting 5 minutes to 72 hour C. At least 50% of episodes are associated with at least 1 of the following

  1. Headache with at least 2 of the following 4 characteristics.
 Unilateral location, pulsating quality, moderate to severe intensity, and aggravation by routine physical activity. 
  1. Photophobia and phonophobia.
  2. Visual aura }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

  • The content in this section is in bullet points.

Don'ts

  • Failure to reassess a child with migraine or tension headache when the headache character changes
  • Attributing persistent nausea and vomiting to an infective cause in the absence of corroborative findings, eg, contact with similar illness, pyrexia, diarrhea
  • Failure to fully assess vision in a young or uncooperative child
  • ▶Failure of communication between community optometry and primary and secondary care
  • Attributing abnormal balance or gait to middle ear disease in the absence of corroborative findings
  • Failure to identify swallowing difficulties as the cause of recurrent chest infections or “chestiness”
  • Attributing impaired growth with vomiting to gastrointestinal disease in the absence of corroborative findings
  • Failure to consider diabetes insipidus in children with polyuria and polydipsia

References


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