"My Head Hurts"
The most common type of headache in childhood associated with "band like" pressure or tightening sensation
tension headache
Progressive, nighttime wakening, and are worse with Valsalva maneuver or exertion are red flags for headaches caused by this
Elevated ICP
While thought to help with headaches, this common substance can lead to chronic headache formation
Caffeine
A part of the physical examination that should be especially performed in its entirety for a patient with a complaint of headache
A thorough neurological examination (with fundoscopic exam if available)
The four major domains of headache treatment are...
1) lifestyle modification
2) acute headache management
3) complementary treatments
4) preventive treatment
In this type of headache, symptoms of vomiting and vertigo may be more prominent than headache
Migraine
A pediatrician is worried about what when a patient presents with a headache she describes at super acute, pounding, and worst headache of her life
Spontaneous intracranial hemorrhage (or ischemic stroke)
After what period of time are you concerned about a post-traumatic headache?
> 2 weeks
The next best step for a patient seen in clinic who complains of <6 months of sleep-related headache, headache waking the patient from sleep, or headache always present in the morning
Transport to ED for neuroimaging to rule out a structural intracranial lesion causing elevated ICP
Bonus 100 points: when do you use a CT > MRI?
A clinician can ask a patient to keep this to identify headache patterns and triggers and to evaluate treatment response
A Headache Diary
Acute febrile viral illnesses, Lyme, Bartonella, HIV, rickettsial illnesses, and this bacterial infection often cause headaches
strep pharyngitis
In these 2 conditions, the patient may present with headache but is distinguished usually by photophobia, nausea, vomiting, and pain with eye movements
Meningitis and Encephalitis
A patient with this disorder complains of being cold and consistently gaining weight and has refractory headaches
Hypothyroidism
An adolescent, seen with their parent, c/o headache but provides a guarded history. The best next step is this.
Converse privately with the adolescent and include questions regarding sexual activity, pregnancy, drugs, cutting behavior, physical or sexual abuse, bullying, depression, family finances, alcohol use, or eating disorders, all of which may affect headache.
Lifestyle modification to suggest for primary headache include
SMART acronym
Sleep: regular and sufficient
Meals: including breakfast and good hydration
Activity: regular aerobic exercise
Relaxation: stress reduction
Trigger avoidance: avoid stress, sleep deprivation, or other triggers
Endocrine disorder that should be considered with refractory headaches
Hypothyroidism
While uncommon, a patient presenting with headache along with focal neurological signs, seizures, decreased level of consciousness, and papilledema is concerning for what disorder.
Sinus venous thrombosis
This mother wants to know what causes her child's morning headaches after endorsing he seems to always be snoring.
OSA (hypercarbia and hypoxia)
These 5 common lifestyle factors often affect headache, often exacerbating or triggering headaches
sleep, diet, exercise, caffeine intake, and stress
Acute treatments for headache include OTC Ibuprofen, Naproxen, Acetaminophen.
However, patients should not use acute treatments more than this time frame per month for NSAIDs due to avoid the risk of developing that.
NO more than 2 to 3 days per week
(<15 days per month
for NSAIDs and <10 days per month for triptans or caffeine)
to avoid developing medication overuse headaches
Category of chronic headache that becomes daily within 3 days of onset and is not caused by another disorder (often associated with EBV infection)
New daily persistent headache (NDPH)
Chiari I Malformation presents usually with occipital headache, ataxia, and vertigo; however, it can be difficult to diagnosis because of what factor
30% will be asymptomatic
During her annual physical, a 16 y/o female seems withdrawn with a poor affect and she complains of headache. You believe these headaches are being exacerbated by what.
Psychiatric Disorder (Depression, Anxiety, etc.)
Per the American Academy of Neurology, this is the recommended step for a child with recurrent headaches who is also experiencing coexistent seizures
Recurrent headaches +
-normal neuro exam: NO neuroimaging
-abnormal neuro exam or coexistence of sz: neuroimaging
-recent onset severe headache, change in headache type, or neuro dysfunction: neuroimaging
These medications are typically used for the prevention of pediatric migraine
Topiramate, b-blockers (propranolol), and tricyclic antidepressants, (amitriptyline and nortriptyline)
A nightly dose of cyproheptadine may be particularly useful in younger children