Headache
MIGRAINE
Epidemiology
Clinical Features
Symptoms
Prognosis and Treatment
TENSION HEADACHE
Clinical Features
Treatment
ORGANIC HEADACHES
Source
Toronto Notes 2012
Epidemiology
- 4-5% of school aged children
- Prevalence F:M = 2:1 after puberty
Clinical Features
Symptoms
- Infant: Irritability,Sleepiness, pallor, and vomiting
- Young child: periodic headaches with nausea and vomiting; relieved by rest
- Unilateral throbbing headaches in kids with photophobia or phonophobia
Prognosis and Treatment
- > 50% spontaneous prolonged remission after 10y
- Analgesia (ibuprofen) and rest in quiet, dark room
- Non-pharmacological treatment and prophylaxis: avoid triggers (poor sleep, stress, cheese, chocolate, caffeine), biofeedback techniques, exercise
- Pharmacological prophylaxis: beta-blockers (e.g. propranolol), antihistamines, antidepressants (e.g. amitriptyline), calcium-channel blockers, anticonvulsants (e.g. divalproex sodium)
TENSION HEADACHE
Clinical Features
- Bilateral pressing tightness anywhere on the cranium or suboccipital region, usually frontal, hurting or aching quality, non-throbbing
- Lasts 30 minutes to days, waxes and wanes, may build in intensity during the day
- No nausea/vomiting, not aggravated by routine physical activity
- Most children have insight into the origin of headache: poor self-image, fear of school failure
Treatment
- Reassurance and explanation about how stress may cause a headache
- Mild analgesia (paracetamol, NSAIDs)
- Supportive counselling
ORGANIC HEADACHES
- Organic etiology often suggested with occipital headache and red flags with increased ICP
- Aetiology: brain tumours, hydrocephalus, meningitis, encephalitis, cerebral abscess, pseudotumour cerebri, subdural hematoma
- Characteristics: diffuse early morning headaches, early morning vomiting, headache worsened by increased ICP (cough, sneeze, Valsalva); as ICP increases, headache is constant and child is lethargic and irritable
- Without increased ICP
- Aetiology: cerebral arteriovenous malformation (AVM), aneurysm, collagen vascular diseases, subarachnoid haemorrhage, stroke
Source
Toronto Notes 2012