Pediatric migraine Flashcards Preview

Neurology > Pediatric migraine > Flashcards

Flashcards in Pediatric migraine Deck (21)
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1
Q

Epidemiology

A

worldwide prevalence 7.7%, school age prevalence 10%, increases w/ age, +c boys before puberty, +c girls during and after puberty

2
Q

Headache classification

A

According to ICDH-3 (international classification of HA disorders 3rd edition):
Primary
Secondary
Due to cranial neuropathies

3
Q

Primary HA

A

Migraine (with or without aura), tension type headache (TTH), trigeminal autonomic cephalalgias (TACs)

4
Q

Migraine pathophysiology

A

Ion channel dysfunction in brainstem that modulates sensory input and meningeal blood vessels
Cranial dilation of blood vessels causing further nerve activation and pain

5
Q

Pediatric migraine criteria

A

ICDH-3. 5-2-1
5 or more attacks not due to other medical diagnosis or medication overdose
2 or more: bilateral location, frontotemporal, pulsating quality, moderate to severe intensity, aggravated by regular physical activity
1 or more: nausea, vomiting, photophobia, phonophobia

6
Q

Tension type headache (TTH)

A
Bilateral 
Mild to moderate in intensity 
Tightening, pressing, squeezing quality 
Increased pericranial tenderness
Not aggravated by regular physical activity 
May or not be associated w nausea 
Photophobia or photophobia may occur
7
Q

Trigeminal autonomic cephalalgias

TACs

A

Unilateral
Moderate to severe to very severe
Stabbing quality
Parasympathetic autonomic features: conjunctival lacrimation/injection, nasal congestion, facial sweating. Ipsilateral

8
Q

Multitiered approach to migraines

A

4 tiers

  1. Lifestyle modifications
  2. Integrative approaches
  3. Pharmacologic tx
  4. Other tx
9
Q

What is key to Dx pediatric migraines?

A

Thorough medical history

10
Q

Questions to ask when taking the Hx? 1-4

A
  1. Pattern of HA and what time do they occur? 2. How and when did the HA begin? 3. How often do they happen and how long do they last? 4. Where is the pain located?
11
Q

Questions to ask when taking the Hx? 5-8

A
  1. What is the quality of the pain? 6. What other symptoms accompany the HA? 7. Anyone in the family has HA? 8. What do you think may be causing your HA?
12
Q

HA patterns?

A
  1. Acute onset of 1st episode w/o prior Hx 2. Recurring HA with symptom free intervals 3. Chronic pattern of progressively increasing HA 4. Nonprogressive daily or near daily HA 5. Mixed pattern of daily HA with + intense attacks superimposed
13
Q

How and when did your HA begin? Rationale

A

Try to establish origin/history of attacks

14
Q

How often? How long? Rationale

A

ID characteristic patterns

15
Q

Pattern of Migraine or TTH (tension type HA)

A

Could be weekly 4 h attack

16
Q

Pattern of TACs (Trigeminal Autonomic Cephalalgias)

A

Brief attacks happening multiple times daily

17
Q

Pain locations for HAs?

A

Holocephalic, bifrontal, unilateral, posterior (occipital)

18
Q

Qualities of HAs

A

Throbbing/pounding, squeezing/pressure, stabbing, other

19
Q

Symptoms that could accompany HAs?

A
Nausea, vomiting, abdominal pain
Visual aura, diplopia
photophobia, photophobia
Vertigo, dizziness
Motion sickness, nocturnal leg cramps
Numbness, weakness
20
Q

What word should you use when taking family Hx?

A

Use the open ended term headache (no migraines) to see if there are other types of HA in the family

21
Q

What do you think maybe causing your HA?

A

Possibly the most important question, MC fear: Brain tumor, but w/ a normal physical and neurological exam you can reassure pt and family