Headache(pediatrics)

Headache is a fairly common symptom in children and adolescents  . The age of the child, the nature of the pain and especially the time classification of the pain play a role in the differential diagnosis.

Content

 * 1Distribution of pain
 * 2Differential diagnosis
 * 2.1Acute pain
 * 2.2Chronic pain
 * 3Diagnostics
 * 4Therapy
 * 5Links
 * 5.1related articles
 * 5.2Reference
 * 5.3External links

Distribution of pain
The headache in time can be divided as follows  :


 * Acute pain - the first, sudden attack of intense headache
 * Acute recurrent pain - a repeated attack of intense headache
 * Chronic progressive pain - long-term headache with increasing frequency of attacks and intensity
 * Chornic non-progressive pain - long-term headache with the same character
 * Chronic daily headache ( CDH) - a headache with a history of more than 4 months and more than 15 episodes per month lasting more than 4 hours

Acute pain
The most common cause of acute headache in children is symptomatic pain in febrile illness, especially in upper respiratory tract infections  . It is necessary to rule out trauma by anamnestic and physical examination. Other causes of acute headache should be considered the first migraine attack or tension headache (see below), then arterial hypertension and especially acute intracranial or extracranial infection:


 * meningitis
 * encephalitis
 * sinusitis ( ethmoidal sinus formed and pneumatized at birth, maxillaris sinus formed at birth and pneumatized at 4 years, sphenoidalis sinus develops around 5 years, frontal sinus develops from 7 years to adulthood  )
 * dental abscess
 * tonsillitis (vertebrovisceral relationship between tonsils and spine)

In contrast, subarachnoid hemorrhage typical of intense acute headache in adults is very rare in children (only 1-2% of patients with subarachnoid hemorrhage are children)  .

Migraine and tension headaches are the most common causes of recurrent headaches in children and adolescents  . Migraines often begin in childhood and are estimated to affect up to 3.5-5% of children  . The pain is localized to areas common to the patient, typically unilaterally, frontally or bitemporally. In children, in contrast to adults, it is more often bilateral  . It is intense to crippling, it has a pulsating character (less often in children than in adults ), worsens during physical activity, lasts from 1 to 72 hours with retreat after sleep, the patient tends to be pale, suffers from nausea, vomiting, photophobia and phonophobia and seeks a quiet and dark place. An "aura" may appear 15-30 minutes before the attack; for migraine in childhood, the aura is typically visual, which is manifested by points or flashes of light in the visual field  . However, up to 60% of patients suffer from aura-free seizures  .

In toddlers, migraine headaches are difficult to verbalize and are manifested mainly by increased irritability, drowsiness, paleness and vomiting. The baby is often found in a "fetal" position lying on the affected side of the head.

Tension headaches tend to be of a weaker intensity, "pressure" in nature, they are most often localized to the whole head, there is usually no nausea, vomiting, photophobia or phonophobia. They may come suddenly after a certain impulse impulse or they may turn into chronicity as a symptom of a psychiatric illness (anxiety, depressive disorder, neurosis )  .

You can find more detailed information on the pages Migraine, Tension headaches .

Rare causes of recurrent pain include epilepsy ( benign occipital epilepsy ), substance abuse, and recurrent trauma.

Chronic pain
Chronic pain of a progressive nature can indicate serious illness. It is necessary to focus the diagnosis on head cancers (astrocytoma, medulloblastoma, glioma, PNET,…), hydrocephalus, pseudotumors , chronic meningitis , brain abscess or subdural process.

Chronic non-progressive and daytime pains include differential pain as a symptom of psychiatric illness in the differential diagnosis.

Diagnostics
Detailed anamnesis (course, epidemiological anamnesis,…), physical examination (body temperature, lymphadenopathy,…), biochemical examination (FW, CRP,…) and blood count (leukocytes, differential,…) will confirm or rule out inflammatory disease.

No imaging is required for typical recurrent headaches without neurological findings and pain-free intervals  . On the contrary, this is immediately necessary in cases where there is a focal neurological finding or a sign of increased intracranial pressure (papillary edema). Other indications for CT or MRI imaging include pain on awakening, pain awake from sleep, pain with acute onset without previous history, progressively worsening pain or pain accompanied by vomiting  .

If meningitis, encephalitis or subarachnoid hemorrhage is suspected, lumbar puncture is indicated. Puncture should be preceded by imaging examination when conditions with increased intracranial pressure or conditions with focal neurological deficit are suspected  . EEG may be appropriate only in cases with suspected epileptic conditions (atypical migraines, etc.).

Treatment
In case of secondary headaches, causal therapy is appropriate.

In migraine, symptomatic acute pain therapy involves resting in a cool, dark, and quiet place, excluding physical activity. The most effective treatment is sleep. Administration of NSAIDs after (eg ibuprofen 5-10 mg / kg and the dose most often after 8 hours) may be effective when administered during the aura or initial phase of the attack, in later phases digestion and thus absorption of the drug from the GIT is suppressed  and nausea and vomiting occur  . Drugs from the triptan group are also available for injection, nasal and sublingual administration  . In the period between attacks, regimen measures (regular sleep, regular eating, elimination of pain-triggering moments) and prophylactic therapy are in place.(TCA, cyproheptadine, anticonvulsants, β-blockers, calcium channel blockers, SSRIs)  .

Links
https://www.wikiskripta.eu/index.php?curid=12513

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