Headache (peds)
Revision as of 07:36, 6 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "== " to "==")
Background
Clinical Features
Differential Diagnosis
Pediatric Headache
- Primary headache
- Secondary headache
Diagnosis
- Predictors of a surgical space-occupying lesion
- Headache of <6 months' duration
- Sleep-related headache
- Vomiting
- Confusion
- Absence of visual symptoms
- Absence of family history of migraine
- Abnormal findings on neuro exam
- Effortless vomiting but no GI complaints suggestive of elevated ICP
Diagnosis
- Neuroimaging
- Routine imaging is not indicated in children w/ recurrent HA headaches and normal neuro exam
- Consider imaging if abnormal neuro exam, AMS, concurrent sz, severe HA or change in type
Treatment
Headache Type | Treatment | Comment |
---|---|---|
Migraine | Ibuprofen, 10 milligrams/kg PO, or acetaminophen, 15 milligrams/kg PO/PR | Ibuprofen superior to acetaminophen in one trial |
Sumatriptan, 10 milligrams via nasal spray (20–39 kg) or 20 milligrams via nasal spray (>40 kg), or 0.06 milligram/kg SC | Nasal or injectable preferred; no difference between oral sumatriptan and placebo | |
Rizatriptan, 5 milligrams PO | Efficacy not statistically significant over placebo | |
Dihydroergotamine, 0.1 milligram/kg (ages 6–9), 0.15 milligram/kg (ages 9–12), 0.2 milligram/kg (ages 12–16) | Contraindicated in complex migraine | |
Prochlorperazine, 0.15 milligram/kg IV | Consider diphenhydramine 1 milligram/kg to prevent or treat dystonic reactions | |
Cluster | 100% oxygen at 7 L/min via non-rebreather mask at onset of headache | Most useful at onset of symptoms, less effective later in course of headache |
Ergotamine, 0.1 milligram/dose (ages 6–9), 0.5 milligram/dose (ages 9–12), 0.75 milligram/dose (ages 12–16) | — | |
Sumatriptan | Nasal spray or IM dosing as for migraine | |
Lidocaine, 1% solution in ipsilateral nostril | Effective for mild to moderate pain, can instill via atomizer and syringe | |
Prednisone, 1–2 milligrams/kg for 10 d with subsequent 7-d taper | Effective at terminating prolonged cluster headaches and preventing recurrence | |
Tension | Ibuprofen, 10 milligrams/kg PO, or acetaminophen, 15 milligrams/kg PO/PR | — |