Migraines and Headaches in Children

00:01 In this lecture, we will review Migraines and Headaches in Children.

00:06 Migraines are a common complaint in children.

00:09 They are more frequent as children get older. And there is many causes of headaches.

00:14 So, a good history goes a long way in figuring out what kind of headache or migraine is going on.

00:20 There are many vascular causes of headaches including Migraine, Common headache, Vasculitis or Aneurysm.

00:29 And as you can see, Aneurysm while rare is extremely severe.

00:33 So, distinguishing between these types of headaches is important.

00:39 Generally, 50% of headaches will start with people under 20 years of age.

00:46 Triggers of migraines can include certain types of food, certain chemicals, alcohol, especially maybe red wine or certain types of alcohol.

00:55 Certain medications can trigger migraines in people.

01:00 And lights and noise can trigger migraines.

01:04 Additionally, psychosocial stress can trigger migraines.

01:07 So people with migraines will tell you there are certain things that tend to set them off.

01:12 And so, avoidance of those things becomes a major part of their lives.

01:18 Migraines rarely present in infants.

01:21 They can present with episodes of Pallor episodes of decreased activity, and episodes of vomiting.

01:28 Often those infants are not capable of saying that their head hurts.

01:32 This can be a very difficult diagnosis.

01:35 In young children, they may develop vomiting in addition to their headache they might have light or noise sensitivity.

01:42 And often migraines are bitemporal.

01:45 So, if there are saying there is a focal headache in one spot, that's probably not a migraine.

01:52 On adolescents migraines tend to be gradual in onset.

01:56 And tend to be a throbbing headache and they are often unitemporal.

02:00 So, in adolescents, they become more unilateral.

02:05 Migraine typically worsens with activity.

02:09 It is important for a migraine patient just to lay still.

02:12 Often they have photophobia or phonophobia so a quiet dark place is an important way to help to get them feeling better.

02:22 Typically migraines can last to 1 but rarely even up to three days.

02:27 So, a one-hour headache, usually tolerable but getting them under control is important.

02:34 Some patients with migraines will say that they sense an aura or see flashing lights or other things.

02:42 This is less common on young children.

02:44 Only about a third do that.

02:47 Generally, auras include visual spots. Seeing colored lights, or even complex images.

02:55 Occasionally, patients can have complicated migraines and this can result in temporary neurological benefits such as weakness or limpness.

03:06 Those are rare but they are definitely known to happen.

03:09 Migraines are controlled best by having a good regimen of sleep, exercise and hydration.

03:17 Of course, if a patient has a particular trigger, that causes them to have migraines, patients should avoid those.

03:24 And over time they developed an understanding of what are the typical triggers of their migraines.

03:31 Therapy is important for migraines. Because these headaches can be debilitating.

03:36 Generally, we provide Ibuprofen very early in the headache.

03:40 Earlier, using Ibuprofen is important as it can stem and reduce the severity of the eventual worseness of the headache.

03:50 Patients can use Sumatriptan nasal spray after 12 years of age in children.

03:55 So, that is a good and effective method and medication for control of migraines.

04:01 Other meds include promethazine prochloperazine and there are others out there.

04:08 So, there are also other types of headaches we should discuss.

04:12 One common type of headache is the tension type of headache.

04:16 Tension headaches are usually diffused in location and non-throbbing.

04:21 They are usually not worse with activity and there is no nausea or vomiting associated with it.

04:27 They can last up to 30 minutes.

04:29 But they can even last up to 7 days. So this could be a very prolonged headache.

04:35 The mechanism of tension headaches isn't quite clear.

04:39 But we usually treat them with Ibuprofen or if they are refractory or not getting better, sometimes people use topiramate.

04:48 Cluster headaches are rare in children under 10.

04:52 They are usually unilateral.

04:54 or frontal or periorbital.

04:58 They have often a trigeminal distribution in the trigeminal nerve.

05:03 And they are usually short but there is multiple headaches over and over again in a short period of time.

05:10 Hence the name, cluster headaches.

05:14 The first-line therapy for cluster headaches interestingly is oxygen therapy.

05:19 We'll put these children on 100 percent oxgyen and then often get better.

05:24 We often will send families home with oxygen tanks to use that to treat their headaches.

05:29 Also, triptans may be useful in the treatment of their headaches.

05:33 Other medicines include, Ergotamine and octreotide.