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in this lecture we will review migraines
and headaches and children migraines are
a common complaint in children they are
more frequent as children get older and
there's many causes of headaches so a
good history goes a long way in figuring
out what kind of headache or migraine is
going on there are many vascular causes
of headaches including migraines the
common headache vasculitis or aneurysm
and as you can see aneurysm wall rare is
extremely severe
so distinguish between these types of
headaches is important
generally 50 percent of migraines will
start in people under 20 years of age
triggers of migraines can include
certain types of food certain chemicals
alcohol especially maybe red wine or
certain types of alcohol certain
medications can trigger triggers trigger
migraines in people and lights or noise
contribs
additionally psychosocial stress can
trigger migraines so people with
migraines will tell you there are
certain things that tend to set them off
and so avoidance of those things becomes
a major part of their lives
migraines rarely present in infants they
can present with episodes of power
episodes of decreased activity and
episodes of vomiting often those infants
are not capable of saying that their
head hurts
this can be a very difficult diagnosis
in young children they may develop
vomiting in addition to their headache
they may have light or noise sensitivity
and often migraines are bitemporal so if
they're saying there's a focal heading
headache in one spot that's probably not
a migraine in adolescence migraines tend
to be gradual and onset they tend to be
a throbbing headache and they're often
uni temporal so when adolescents they
become more unilateral migraines
typically worsen with activity it's
important in a migraine patient just to
lie
still often they have photophobia or
photophone eeeh so a quiet dark place is
an important way to help get them
feeling better
typically migraines can last either one
but rarely up to even three days so a
one-hour headache usually tolerable but
getting them under control is important
some patients with migraines will say
that they sense an aura or see flashing
lights or other things this is less
common in young children only about a
third do that generally auras include
visual spots seeing colored lights or
even complex images occasionally
patients can have complicated migraines
and these can result in temporary
neurologic deficits such as weakness or
limpness those are rare but they are
definitely known to happen migraines are
controlled best by having a good regimen
of sleep exercise and hydration of
course if a patient has a particular
trigger that causes them to have
migraines patients should avoid those
triggers and over time they develop an
understanding of what are the typical
triggers of their migraines therapy is
important for migraines because these
headaches can be debilitating generally
will provide ibuprofen very early in the
headache earlier use of ibuprofen is
important as it can stem and reduce the
severity of the eventual worst Ness of
the headache patients can use
sumatriptan nasal spray after 12 years
of age in children so that's a good and
effective method and medication for
control of migraines other meds include
promethazine prochlorperazine and
there's others out there so there are
also other types of headaches we should
discuss one common type of headache is
the tension type headache tension
headaches are usually diffuse in
location and non throbbing they're
usually not worse with activity and
there's no nausea
vomiting associated with it they can
last up to 30 minutes but they can even
last up to seven days so these can be a
very prolonged headache the mechanism of
tension headaches isn't quite clear and
we usually treat them with ibuprofen or
if they're refractory and not getting
better sometimes people use topiramate
cluster headaches are rare in children
under 10 they're usually unilateral and
front or frontal or periorbital they
have often a trigeminal distribution in
the trigeminal nerve and they are
usually short but there's multiple
headaches over and over and over again
in a short period of time hence the name
cluster headaches the first-line therapy
for cluster headaches interestingly is
oxygen therapy will put these children
on a hundred percent oxygen and they
often get better we often will send
families home with oxygen tanks to use
that to treat their headaches also
triptans may be useful in the treatment
of their headaches other medicines
include pergamene and octreotide
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