Dr Nagi G Barakat

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• Dr Nagi G Barakat
• Consultant Paediatrician
• Hillingdon Hospital

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Types of Headaches

• Acute
• Acute recurrent
• Chronic progressive
• Chronic nonprogressive
• Cluster headache
• Epileptic headache
• Psychogenic
• Mixed

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Acute Headache

• It could be migraine
• Cerebrovascular bleed(CT or MRI with contrast)
• Trauma (CT)
• Meningitis (LP )
• Encephalitis (EEG and CT or MRI)
• Drugs (urine toxicology)

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Acute recurrent

• Migraine headache
• Patients history (recurrent pattern)
• Family history
• Visual aura
• Nausea
• Unilateral pain (throbbing)
• Gastrointestinal symptoms
• Exclude other causes

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Migraine

• Hippocrates described migraine
• Galen first used the term hemicrania
• Incidence 1.2 -3.2 at age of 7 years , and
  4-19 by age of 15 years
• More prevalent in females
• Have genetic component
• 2.8 school days per year lost as result of
  migraine
• Children commonly have migraine without aura
• Children not usually having unilateral headache
• Vasodilatation,vasoconstriction,oedema, and
  inflammation of cerebral vessels produce pain

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Clinical features of migraine attack

• Prodrome (change in mood or activity level)
• Aura( occurring in 10-50 of paediatric
  migraine attacks) Photopsia, scotoma, numbness,
  tingling, ataxia, dizziness, and vertigo.
• Headache( Barlow et al, 300 pts with juvenile
  migraine, only 9 of attacks were children
  awakened from sleep by the onest of a migraine
  and only 4 of attacks did they begin on
  awakening)
• Resolution( headache may last 1-4hrs, sleep and
  analgesic)
• Postdrome( Lethargy, anorexia and mood
  disturbances)

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Types of migraine (HIS 1988)

• Migraine with aura(Classical migraine)
• Migraine without aura (common migraine)
• Complicated migraine (hemiplegic migraine,
  ophthalmoplegic migraine,confusional migraine,
  Basilar artery migraine
• Atypical forms of migraine
• Cyclic vomiting
• Recurrent abdominal pain

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Chronic progressive

• Daily headache with increase in severity and
  frequency
• Intercranial pathology should be suspected
• Not responding to analgesia
• May or may not associated with neurological
  symptom and signs
• May or may not associated with behavioural
  problems
• Need investigations including neuroimaging in
  most of patients
• Benign intracranial hypertension should be
  considered

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Brain Tumour

• Uncommon in school-age children
• Incidence is 0.003
• Additional neurological symptoms and signs on
  examination
• Honig and Charney( 72 children with brain tumour
• 94 with abnormal neurological examination
• 85 with abnormalities on CNS examination within
  2 months of presentation
• Childhood brain Tumour consortium
• 3291 children with brain tumour
• Headaches at time of diagnosis in 58 of
  Supratontorial and 70 of Infratontorial
• 99 of children with headaches and brain tumour
  had at least 1 abnormal neurological symptom and
  98 had at least 1 abnormal neurological sign

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Astrocytoma
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Medulloblastoma
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Chronic non-progressive

• Tension headache
• At the end of the day on every day most days
• Often not responding to analgesia and may cause
  rebound headache
• Frequent school absence
• More in females
• Often respond to relaxation therapy and
  behavioural intervention
• Systematic review is important
• Therapeutic plan (check life style, school
  attendance mandatory,counselling, behaviour and
  stress therapy and biofeedback is important)

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Organic Causes of headaches

• Brain tumours
• CNS infection(TB, chronic meningitis, abscess)
• Arterial hypertension and vascular malformation
• Benign increase intracranial pressure
• Hydrocephalus and congenital malformation
• Para nasal sinusitis
• Endocrine and metabolic causes ( hypoglycaemia)