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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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