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.