5/5/2010
Headaches in Children
Headaches in Children Farjam Farzam, M.D. Pediatric Neurology University of Kentucky
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Headaches in Children • Prevalence: ‐7 years old: 35‐50% ‐15 years old: 60‐80%
Headaches in Children • • • • • •
Challenging diagnosis in young children. Limited verbal, language abilities. Poor localization, quality. Non‐specific complaint. Pain rating scale: not helpful. Associated with other illnesses.
Common complaint in pediatric population. All age groups. 2‐3 years old. Teenagers/Adolescents. 3‐4 per month. School absenteeism. Effective: 4‐6 weeks
Migraine Prophylaxis * Tricyclic antidepressants: •Amitriptyline (Elavil): 10‐50 mg/day. •Nortriptyline (Pamelor): 10‐50 mg/day.
Migraine Prophylaxis • Calcium channel blockers: ‐Not as effective. ‐Beneficial for Familial Hemiplegic migraines.
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Analgesic Rebound Headache Common in children; Migraine patients Dull, generalized, low intensity Frequent, cyclic OTC use Interfere with activities Management: discontinue/minimize analgesic use • Effects: 4‐6 weeks
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Caffeine Headaches • • • •
Caffeine Headache • Cycle: ‐Use more to relieve/avoid headaches. ‐ Addiction • Mechanism: direct effect, withdrawal Mechanism: direct effect withdrawal • Management: ‐ Discontinue Caffeine ‐ Effects: 4‐6 weeks
Tension Headaches • Headaches: ‐Dull, aching ‐Diffuse, bilateral ‐Morning: last all day all day ‐Almost Almost daily daily ‐No nausea, vomit, photo/phonophobia
Common in children, adolescents. Soft drinks, Tea, Coffee, chocolate milk Headache: dull, diffuse, frontotemporal areas. Anxiety, malaise.
Tension Headaches • • • • •
Stress, Depression, Anxiety Divorce, custody battles Abuse: physical, sexual, verbal School problems Peer relations
Tension Headaches • Examination: normal • Analgesic rebound headache: may be present • Management: ‐ Address/resolve the cause of stress ‐ dd / l h f Discontinue analgesics.
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Sinusitis • Common diagnosis: parents, PCP • Fever, cough, congestion, poor airway clearing. • Tenderness: frontal, maxillary sinuses d f l ill i • Pain behind nose: Ethmoidal, Sphenoidal sinuses.
Pseudotumor Cerebri • Idiopathic Intracranial Hypertension (IIH) • Syndrome: ‐ Increased Intracranial pressure (ICP) (+/‐) Papilledema ‐ Papilledema Normal brain imaging results ‐ Normal CSF content.
Pseudotumor Cerebri • Drugs: Vitamin A Tetracycline Corticosteroids Thyroid replacement Nalidixic Acid Oral Contraceptives
• Infections: Otitis Media Sinusitis Mastoiditis • Head Trauma
Sinusitis • Increased pain: ‐ Blowing nose ‐ Bending head forward g • Diagnosis: ‐ Clinically, X‐Rays, CT scans. ‐ Asymptomatic, coincidental. • Treatment: ‐ Decongestants, antibiotics, surgery.
Pseudotumor Cerebri • Idiopathic: >11 years old. • Causes:
