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Pediatric Headaches

Pediatric Headaches. Pediatric Pain Resource Nurse Curriculum. Pediatric headache: prevalence and classification. Etiology dictates treatment plan If unknown cause, goal is pain relief or reduction 60% of children experience a headache in a 3 month period 4% of preschoolers

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Pediatric Headaches

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  1. Pediatric Headaches • Pediatric Pain Resource Nurse Curriculum

  2. Pediatric headache: prevalence and classification Etiology dictates treatment plan If unknown cause, goal is pain relief or reduction • 60% of children experience a headache in a 3 month period • 4% of preschoolers • 10% of school-aged children (girls 1:1 boys) • >16% of adolescents (more girls 3:1 boys) • 17% reporting severe headache in the last year • Headache classification • Primary • Secondary

  3. Headache evaluation In addition to obtaining a thorough comprehensive pain history, determine: • Is this the first evaluation? • Has the child already been diagnosed with migraines but there had been a sudden change? • Is the child able to play during the headache? • Is the headache getting less responsive to treatment? • Are there any known triggers of headache? • Are there associated symptoms?

  4. Headache evaluation • Red flags: when to worry • Awakens child • Onset: sudden, abrupt, split-second (thunderclap) • Neurologic symptoms or abnormal findings • Worse when lying down, coughing, Valsalva • Recurrent, localized • Lasting more than 6 months • Systemic symptoms (fever, weight loss) • Previous headache history or headache progression

  5. Marla • Marla is a 10-year-old girl who presents to the ED with what she reports as the worst headache ever. • Has had headaches; treated with ibuprofen and rest • No recent injury or environment/school changes • How will you assess Marla’s headache symptoms?

  6. Migraine • An inherited, chronic disorder with episodic attacks • Children 3-7y (1-3%), Adolescents (8-23%) • More common in girls than in boys • Focus treatment on prevention to reduce frequency and severity of headaches • Types of migraines • Status migrainous • Migraine with aura • Migraine without aura

  7. Treatment plan for migraines • Manage Triggers • Stress • Fatigue • Illness • Fasting • Dehydration • Food • Use Pharmacologic Treatment • Abortive: NSAIDS, Triptans, Opioids • Preventative: Cyproheptadine, Antiepileptics, Tricyclic antidepressants Consider Neutraceuticals

  8. Other headaches • Tension-type headache • Most common type of primary headache • Headache lasting 30 min to 7 days • May be episodic or chronic • Not accompanied by nausea, vomiting, photophobia or phonophobia • Chronic daily headache • Primary HA ≥ 15days per month lasting >4hours • Prevalence in children unknown • Four types: Chronic migraine, Chronic tension type headache, New daily persistent headache, Hemicrania continua

  9. Long-term goals for managing headache pain • Reduce frequency • Reduce reliance on ineffective acute medications • Improve quality of life • Balance biobehavioral with pharmacology • Biobehavioral treatments include: • Stress management • Sleep hygiene • Exercise • Dietary modifications

  10. SMART headache management

  11. Secondary Headaches

  12. Biobehavioral headache management

  13. ? Marla • What questions do you need to ask in order to development an appropriate treatment plan? • Headache started upon waking, vomiting • Keeps head covered, bothered by lights • Felt weird last night, no visual symptoms • Headache worse with movement and lying down • Doing well in school; rewarded with coffee drink

  14. Marla • Case summary • Work-up was negative • Patient improved with hydration, ketorolac • Discussed triggers • Reviewed rescue plan: naproxen, rizatriptan • Discussed SMART headache management • Shared video as part of education • Migraine: How it works and how to get it under control (7:30) • Marla’s treatment plan: • Workup • Triggers • Rescue plan

  15. In Summary

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