OVERVIEW & MANAGEMENT OF HEADACHES IN CHILDREN..NICE GUIDLINES ON IMAGING IN HEADACHES

3. pain in the head

4. Preschool
Schoolchildren

6. MIGRAINE
TENSIONTYPE
HEADACHE
(TTH)
TRIGEMINAL
AUTONOMIC
CEPHALALGIAS
(TACS)
eg cluster headaches

8. HEADACHE ATTRIBUTEDTO ;

10. HEADACHE
FEATURE
TENSIONTYPE
HEADACHE
MIGRAINE with & without Aura CLUSTER HEADACHE
Pain
location
Bilateral Unilateral or bilateral Unilateral (around the eye,
above the eye and along the
side of the head/face)
Pain quality Pressing/tightening
(non-pulsating)
Pulsating , throbbing or banging Variable (can be sharp,
boring, burning, throbbing
Pain
intensity
Mild or moderate Moderate or severe Severe or very severe
Effect on
activities
Not aggravated by
routine activities
Aggravated by, or causes avoidance of, routine
activities of daily living
Restlessness or agitation
Duration 30 minutes–
continuous
4–72 hours in adults
1–72 hours in young people
15–180 minutes
Other
symptoms
NONE
Aura
Symptoms fully
reversible
develop over at least
5 minutes
last 5−60 minutes
Unusual sensitivity to light and/or sound or
nausea and/or vomiting
Typical aura symptoms visual symptoms such
as;
flickering lights, spots or lines and/or partial loss
of vision; sensory symptoms such as numbness
and/or pins and needles; and/or speech
disturbance
On the same side as the
headache:
red and/or watery eye
nasal congestion
swollen eyelid
forehead and facial
sweating
constricted pupil and/or
drooping eyelid

11. Examination
Brain Imaging

13. Bleed?
Headaches all day
on most days
18 months
TTH?
Recurrent severe headaches
Once a month
2 years without progression
Family Hx?
Migraine?
Headaches every few months
then weeks
then days
Now every day
Tumour?
Severe headaches all day for 12 days
2 months ago
None since
Bleed?

14. Blood pressure
Bruit
Vision
Acuity
Fields including blind spot
Extraocular movements
Long tract signs
Tone
Power
Reflexes
Cerebellar signs
Finger-nose test (eyes shut)
Tremor
Dysarthria
Gait

15. • worsening headache with fever
• sudden-onset headache reaching maximum intensity within 5 minutes
• new-onset neurological deficit
• new-onset cognitive dysfunction
• change in personality
• impaired level of consciousness
• recent (typically within the past 3 months) head trauma
• headache triggered by cough, valsalva or sneeze
• headache triggered by exercise
• orthostatic headache (headache that changes with posture)
• symptoms suggestive of giant cell arteritis
• symptoms and signs of acute narrow angle glaucoma
• a substantial change in the characteristics of their headache.

16. compromised immunity
under 20 years
malignancy
vomiting

17. headache diary
minimum of 8 weeks

18. Abnormal neurologic examination.
Abnormal or focal neurologic signs or symptoms ;
Seizures or very brief auras ( < 5 min).
Unusual headaches in children ;