Childhood Headche

8/10/2019 Childhood Headche

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CHILDHOOD

HEADACHE

bambanghartono

Bagian Ilmu Penyakit Saraf

RS Bayukarta

Karawang


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Prevalence (%) of headache and migraine

at school age

0

5

10

15

20

25

30

(%)

5 6 7 8 9 10 11 12 13 14 15 all

age (years)

Female Male TOTAL

Abu-Arafeh & Russel (1994)

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Headache in School-age Children

0

5

10

15

20

25

prevalence(%)

Migraine-Aura Migraine+Aura

Complicated Migraine Episodic TH

Chronic TH Mixed Migraine+ET

Mixed migraine+CTH Non-specific headache

Others

Abu-Arafeh & Callaghan 2002

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ACUTE

ACUTE

RECURRENT

CHRONIC

PROGRESSIVE

CHRONIC

NON-PROGRESSIVE

HEADACHE TYPESTemporal patterns of four major clinical profiles of headache in children

bambanghartono


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HEADACHE TYPESTemporal profiles of mixed or comorbid headaches

(migraine is superimposed on chronic tension-types headache)

bambanghartono


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The IHS Classification of

Types of Migraine

Migraine without aura

Migraine with aura

Ophthalmoplegic migraine

Retinal Migraine

Childhood periodic syndromes that may be

precursors to associated with migraine

Complications of migraine

Migrainous disorder not fulfilling abovecriteria

bambanghartono


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Pediatric migraine without aura Pediatric migraine with aura

Diagnostic Criteria Diagnostic Criteria

A. At least five attacks fulfilling B-D A. At least two attacks fulfilling B

B. Headache lasting 1-48 hours B. At least three of the following

C. Headache at least two of the 1. One or more fully reversible aura

following: symptoms indicating focal cortical

1. Bilateral location (fontal/tem- and/or brainstem dysfunction

poral) or unilateral location 2. At least one aura developing gradually

2. Pulsating quality over more than 4 minutes, or two or

3. Moderate to severe intensity more than 4 minutes, or two or more

4. Aggravation by routine symptoms occurring in succession

physical activity 3. No aura symptoms lasting more than

D. During headache, at least one 60 minutes

of the following: 4. Headache follows after less than 60

1. Nausea and/or vomiting minutes

2. Photophobia and/or

phonophobia

Proposed revised IHS classification

Rothner (2002)

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Signs Suggestive of

Symptomatic (secondary) Headache

Confusion, impaired conscious level

Other signs of raised intracranial pressureLarge or accelerating head circumference

Cracked pot sign

Papill-edemaVI nerve palsy

High blood pressure with low heart rate

Other signs of CNS diseaseCranial nerve palsies/brainstem signs

Other focal neurological deficitsCerebellar signs

Signs of systemic diseaseAcutely unwell

Underlying disease

bambanghartono


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1. Raised intracranial pressure

Hydrocephalus

Cerebral edema

Idiopathic (benign) intracranial hypertension2. Meningeal and intracranial vessels

3. Central (thalamic) pain

4. Epilepsy

5. Cranial and local pathology

6. Systemic7. Miscellaneous

8. Adverse drug/substance reactions

9. Psychological

Main Categories of

Symptomatic (secondary) Headache

bambanghartono


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Symptoms suggestive of symptomatic headache

bambanghartono

Past and current history of known:

Brian tumor, tuberous sclerosis, neurofibromatosis

Hydrocephalus, hindbrain hernia, SAH, meningitis

Head/neck injury

Treatment history of:

Anticoagulation, drugs, LP, neurosurgery

Headache historySingle/first severe headache

Recurrent severe headache for a few weeks

Headache timing and posture

Mainly from sleep

In the morning before getting up, mainly or worse lying down,

relieved upright, worse with cough, bending over, mainlyupright, relieved lying down

Associated symptoms

Vomiting from sleep or in the morning before getting up,

confusion, altered personality, focal weakness, diplopia, fever,

seizures


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Medical and Dietary Management

of Childhood Headache & Migraine

General approach to treatment

Non-pharmacological treatment of migraine

Environment and life-style

Dietary factors

Headache diaries

Other non-pharmacological treatments

Drug treatment of migraine Attack treatment

Prophylactic treatment

bambanghartono

b b h t


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Drugs that can be used in the treatment

of migraine in children

bambanghartono

Attack treatment Single dose (mg/kg) Maximal dose (mg/kg/day)

AnalgesicIbuprofen 10-20 40

Paracetamol 10-15 60

Anti-emeticMetoclopramide oral/rectal 0.15-0.30 0.5-1.0

IM or IV 0.1 0.3

Prochlorperazine oral/rectal 0.1-0.3 0.4-0.5

Specific anti-migrainedrugsSumatriptan not known not known

Prophylactic treatment daily dose (mg/kg/day) maximal dose (mg/day)Propanolol 0.5-2.0 160


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ACUTE HEADACHE

PATIENT FEBRILE PATIENT AFEBRILE

NO NUCHAL

RIGIDITY

NUCHAL

RIGIDITY

GENERAL EXAM

SINUS X-RAY

TREAT UNDERLYING

ILLNESS

LUMBAR PUNCTURE

NORMAL

CSFMENINGITIS

URINALYSIS

CHEST RO

ABNORMAL

NEUROLOGIC

FINDINGS

NORMAL

NEUROLOGIC

FINDINGS

NO MASSMASS

LUMBAR PUNCTURE

WBC RBC

SUBARACHNOID

HEMORRHAGE

ASK ABOUT

DRUG USE

CHECK BP

AND CBC

IF NORMALFOLLOW FOR POSSIBLE

CHRONIC HEADACHE

OR

INTRACRANIAL LESION


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CHRONIC HEADACHE

Normal neurologic

findings

Episodic

nonprogressive

headache

Increasingly

Severe headache CT scanAbnormal

Neurologic finding

Criteria for

migraine

present absent

migraine Episodic

headcahe

Persistent

headache

Occipital neuralgia

TM joint dysfunction

Muscle contraction

Sinus disease

Ocular disorder

Tension

Muscle contraction

Psychogenic

Mass Normal

Lumbar puncture

normal Increased pressure

Normal cells

Protein, glucose

cells

Migraine

Tension headache pseudotumorChronic

meningitis

bambanghartono


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Summary of Management of

Childhood Headache

bambanghartono

Majority cases of headache in children is primary headache:

migraine and chronic tension headache

The prevalence of headache is increased along with age

The history taking should be comprehensive as well as neurological

examination. If necessary diagnostic tests were needed.Management of headache in children consist of : general approach

to treatment, non-pharmacological treatment: environment and life-

style, dietary factors, headache diaries, behavioral treatments. In

drug treatment particularly for migraine, attack treatment and

prophylactic treatment are needed.In secondary headache, exploring the causes of headache is

important.

Documents

Childhood Headche