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PEDIATRIC HEADACHES migraine

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									PEDIATRIC HEADACHES


  • Lawrence D. Beem, D.C.
          Professor
               Pediatric Headaches

    • Children get headaches too, and can be a common
                     complaint in children.
  • It is important that these symptoms not be overlooked
• Occasionally, childhood headaches may be a warning of a
  serious health problem and should be carefully investigated
     • Headaches may be primary or secondary to, or a
               manifestation of, another disorder
                   Pediatric Headaches
• Childhood headaches may be symptoms of a more serious problem
    – Headaches in children may be due to brain tumors
       • A child with a brain tumor will usually complain of headache which
         gradually increases over the preceding weeks or months.
       • Any child with a headache that occurs early in the morning, or
         awakens the child, must be evaluated accurately for the presence of a
         tumor.
       • The warning signs of a brain tumor may include: headaches which are
         persistent, awaken the child or occur in the morning, increase with
         valsalva’s maneuver, vomiting, or a associated with change in
         behavior.
        • Other warning signs: changes in head circumference, double
          vision, strabismus, Parinaud’s phenomenon – inability to raise
          the eyes, papilledema – edema of the optic disc, a child
          presenting with one eye closed, closing the eye or tilting the
          head to reduce double vision, ataxia café au lait spots or
          axillary freckling.
      Pediatric Headaches ( Meningitis)

• Childhood headaches may be due to meningitis, another life-
  threatening condition:
    – Untreated meningitis is usually rapidly fatal, and delay in treatment
      generally increases the chance of death or poor prognosis.
    – 90% of meningitis cases occur in children between 1 month and 5 years of
      age, with the first year of life being the period of greatest risk.
    – In the young infant: signs of irritability, lethargy, poor feeding and
      restlessness may be the only indications of meningitis.
    – Increased intracranial pressure may give rise to a bulging fontanelle and
      headache.
    – Classic signs of meningitis: headache, stiff neck – associated with nuchal
      rigidity, positive Brudzinski sign – Patient in supine position, flex the
      patient’s chin to the chest and observing involuntary flexing of the hips.
         Pediatric Headaches (Migraine)
• Migraines are classified with or without aura.
• Migraines are the most common headaches in children, but are seen in
  children 6 – 10 years old.
• Migraines are characterized by recurrent headaches, separated by a
  symptom-free interval and accompanied by any 3 of the following:
  abdominal pain, nausea, vomiting, throbbing or pulsating headache,
  pain confined to one side of the head, complete relief after rest, visual,
  sensory or motor aura, and a positive family history.
• Migraines usually have a distinct beginning, then increase for a period
  of hours, then decrease.
• Patients often go without a headache for weeks.
• Classic migraine usually begins with a prodromal aura due to
  intracranial vasoconstriction, during which the child experiences loss
  of function, loss of vision, scintillating scotomas, hemianopsia,
  dysesthesia, and motor function loss.
        Pediatric Headache (Migraine
                  Continued)
• After the aura ceases: extracrainal vasodilation takes place
  and a throbbing, nauseating headache follows, usually
  contra lateral to the motor or sensory symptoms.
• The child usually has a loss of appetite, becomes a
  photophobic and/or audiophobic, and needs to sleep.
• The headache is usually gone upon waking.
• Migraine headaches are frequently caused by psychologic
  stresses and diseases.
• The classic features of migraine headaches with aura are
  auras preceding the headache and focal localization of the
  headache.
     Pediatric Headache (Cervicogenic)
• The concept that headache can come from cervical dysfunction is still
  foreign to most of the medical profession.
• “Many headaches are caused by damaged structures in the neck --- and
  scientific evidence proves it.” Robert Maigne
• “Its true that chiropractors have been saying this for years.
  Unfortunately, many medical doctors tend to have a jaundiced view of
  chiropractors, but they were right about headaches.” Dr. Rothbart
• The childhood incidence is unknown.
• Cervicogenic is also referred to as muscle tension headache and
  children report that they have a headache which feels like a band
  squeezing around their head.
• A majority of the patients with tension-type headache were found to
  have a straightened cervical spine, which suggest excessive sub-
  occipital muscle tension, usually respond rapidly to adjustment of the
  cervical spine.
            Pediatric Headache (Other)
• Cluster Headache: Childhood incidence of cluster headaches is rare.
• They are unilateral, have a rapid onset, and the duration time is brief,
  but they may occur up to several times a day.
• Most tend to begin after the age of 20.
• Males tend to predominate.
• Many also had pain radiating to the temple or ipsilateral maxilla or
  forehead.
• Signs and Symptoms: Ocular symptoms including lacrimation,
  conjunctival injectio, photophobia, ptosis, meiosis, nasal congestion,
  rhinorrhea, nausea, sweating of the face and/or other parts of the body,
  phonophobia, and facial flushing.
• The frequency and duration of headaches may increase with time.

								
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