Headache



Headache


Abdullah Al-Anazi



Introduction



  • 60-70% of children experience headache by the age of 7-9 years


  • Relatively unusual presentation in pediatric patients as an isolated complaint (0.7% to 1.3% of visits)


  • Essential to rule out life-threatening causes


  • Laboratory test and imaging modalities are rarely needed


History



  • Mode of onset, pattern, duration, frequency, and location of headache



    • Abrupt onset with extreme pain: consider rupture of AV malformation


    • Occipital location: consider posterior fossa tumor


  • Severity of pain, exacerbating and relieving factors



    • Headache that worsens with bending over or coughing: consider sinusitis or raised intracranial pressure


  • Time and circumstances of headache



    • Early morning headache or one that awakens a child from sleep: consider brain tumor or increased intracranial pressure


  • Associated symptoms (fever, vomiting, neck pain, photophobia, visual change, etc.)



    • Vomiting is the most commonly associated symptom in patients with intracranial pathology (present in 74%)


  • Analgesia and response to therapy


  • Any change from previous headache pattern


  • Recent or remote trauma


  • Exposure to medication or toxin


  • Preexisting medical problems (VP shunt, malignancy, hematologic disease)



  • Psychosocial history


  • Family history of headaches or migraine


Examination



  • Appearance (sick or well looking)


  • Vital signs including blood pressure and temperature


  • General physical exam, including sinus or dental tenderness, nuchal rigidity, lymphadenopathy, heart murmurs, cutaneous lesions, cranial bruits, and visual acuity


  • Complete neurological examination


Clinical Classification



  • Based on temporal pattern of headache


  • Five patterns: acute, acute recurrent, chronic progressive, chronic nonprogressive, and mixed pattern


Acute Headache



  • Single episode without prior history


  • Usually secondary to an upper respiratory febrile illness (e.g., URTI, sinusitis, otitis media)


  • In toxic-appearing patient with fever: consider meningitis (look for signs of meningeal irritation)


  • Suspect subarachnoid hemorrhage if sudden onset and very severe headache


Acute Recurrent Headache



  • Recurrent episodes of headache with symptom-free intervals


  • Differential includes migraine and its variants, tension headache, cluster headache, and neuralgia


Migraine Headache

Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Headache

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