1. Headache

2. Agenda History Physical Classification Management

3. History Chronicity –Duration –Frequency –Acute vs. chronic Location Severity Radiation Quality/character PMH Family History Medications Ameliorating or exacerbating factors Social History and effect on activity

4. Physical ABCs Vitals HEENT – fundoscopic exam CV Pulm MSK – reproducible (TMJ, occipital, etc.) Neuro Skin

5. Classification Primary Tension – bilateral tightness, intermittent and recurring Cluster – unilateral, frontal-periorbital Migraine – paroxysmal w/ autonomic symptoms, chronic and remitting Chronic daily headache Idiopathic intracranial hypertension Secondary Infection –Meningitis –Encephalitis –Abscess –Central venous thrombosis –Sinusitis –Pharyngitis –Otitis media Tumor Intracranial hemorrhage CO poisoning Hypertension

6. Management Neuro imaging not indicated for recurrent HA w/ normal neuro exam Consider CT for new onset migraine w/ normal exam MRI for HA associated w/ sleep, emesis, and/or abnormal exam inc. skin findings LP after imaging if concerned for infection or increased ICP

7. Management All headaches NSAIDs –Ibuprofen –Naproxen –Ketorolac Acetaminophen Amitriptyline Biofeedback Counseling Migraines Abortive –Antimemetics –Ergotamine –Triptans Prophylactic –Cyproheptadine –B blockers –Valproate + folate –Amitriptyline –Other AEDs

8. References Lewis DW, Dorbad D. The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache. 2000 Sep;40(8):629-32.Lewis DWDorbad D Brazis, Paul, et al. Approach to the child with headache. www.uptodate.com www.uptodate.com Cruse, Robert. Classification of migraine in children. www.uptodate.com www.uptodate.com Cruse, Robert. Management of migraine headache in children. www.uptodate.com www.uptodate.com Cruse, Robert. Tension headache in children. www.uptodate.comwww.uptodate.com King, Christopher. Emergent evaluation of headache in children. www.uptodate.com www.uptodate.com