Migraines and Headaches in Children

by Brian Alverson, MD

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    00:01 In this lecture, we will review Migraines and Headaches in Children.

    00:06 Migraines are a common complaint in children.

    00:09 They are more frequent as children get older. And there is many causes of headaches.

    00:14 So, a good history goes a long way in figuring out what kind of headache or migraine is going on.

    00:20 There are many vascular causes of headaches including Migraine, Common headache, Vasculitis or Aneurysm.

    00:29 And as you can see, Aneurysm while rare is extremely severe.

    00:33 So, distinguishing between these types of headaches is important.

    00:39 Generally, 50% of headaches will start with people under 20 years of age.

    00:46 Triggers of migraines can include certain types of food, certain chemicals, alcohol, especially maybe red wine or certain types of alcohol.

    00:55 Certain medications can trigger migraines in people.

    01:00 And lights and noise can trigger migraines.

    01:04 Additionally, psychosocial stress can trigger migraines.

    01:07 So people with migraines will tell you there are certain things that tend to set them off.

    01:12 And so, avoidance of those things becomes a major part of their lives.

    01:18 Migraines rarely present in infants.

    01:21 They can present with episodes of Pallor episodes of decreased activity, and episodes of vomiting.

    01:28 Often those infants are not capable of saying that their head hurts.

    01:32 This can be a very difficult diagnosis.

    01:35 In young children, they may develop vomiting in addition to their headache they might have light or noise sensitivity.

    01:42 And often migraines are bitemporal.

    01:45 So, if there are saying there is a focal headache in one spot, that's probably not a migraine.

    01:52 On adolescents migraines tend to be gradual in onset.

    01:56 And tend to be a throbbing headache and they are often unitemporal.

    02:00 So, in adolescents, they become more unilateral.

    02:05 Migraine typically worsens with activity.

    02:09 It is important for a migraine patient just to lay still.

    02:12 Often they have photophobia or phonophobia so a quiet dark place is an important way to help to get them feeling better.

    02:22 Typically migraines can last to 1 but rarely even up to three days.

    02:27 So, a one-hour headache, usually tolerable but getting them under control is important.

    02:34 Some patients with migraines will say that they sense an aura or see flashing lights or other things.

    02:42 This is less common on young children.

    02:44 Only about a third do that.

    02:47 Generally, auras include visual spots. Seeing colored lights, or even complex images.

    02:55 Occasionally, patients can have complicated migraines and this can result in temporary neurological benefits such as weakness or limpness.

    03:06 Those are rare but they are definitely known to happen.

    03:09 Migraines are controlled best by having a good regimen of sleep, exercise and hydration.

    03:17 Of course, if a patient has a particular trigger, that causes them to have migraines, patients should avoid those.

    03:24 And over time they developed an understanding of what are the typical triggers of their migraines.

    03:31 Therapy is important for migraines. Because these headaches can be debilitating.

    03:36 Generally, we provide Ibuprofen very early in the headache.

    03:40 Earlier, using Ibuprofen is important as it can stem and reduce the severity of the eventual worseness of the headache.

    03:50 Patients can use Sumatriptan nasal spray after 12 years of age in children.

    03:55 So, that is a good and effective method and medication for control of migraines.

    04:01 Other meds include promethazine prochloperazine and there are others out there.

    04:08 So, there are also other types of headaches we should discuss.

    04:12 One common type of headache is the tension type of headache.

    04:16 Tension headaches are usually diffused in location and non-throbbing.

    04:21 They are usually not worse with activity and there is no nausea or vomiting associated with it.

    04:27 They can last up to 30 minutes.

    04:29 But they can even last up to 7 days. So this could be a very prolonged headache.

    04:35 The mechanism of tension headaches isn't quite clear.

    04:39 But we usually treat them with Ibuprofen or if they are refractory or not getting better, sometimes people use topiramate.

    04:48 Cluster headaches are rare in children under 10.

    04:52 They are usually unilateral.

    04:54 or frontal or periorbital.

    04:58 They have often a trigeminal distribution in the trigeminal nerve.

    05:03 And they are usually short but there is multiple headaches over and over again in a short period of time.

    05:10 Hence the name, cluster headaches.

    05:14 The first-line therapy for cluster headaches interestingly is oxygen therapy.

    05:19 We'll put these children on 100 percent oxgyen and then often get better.

    05:24 We often will send families home with oxygen tanks to use that to treat their headaches.

    05:29 Also, triptans may be useful in the treatment of their headaches.

    05:33 Other medicines include, Ergotamine and octreotide.

    About the Lecture

    The lecture Migraines and Headaches in Children by Brian Alverson, MD is from the course Pediatric Neurology. It contains the following chapters:

    • Introdauction to Headaches
    • Clinical Presentation of Migraines
    • Management of Migraines
    • Management of other Types of Headaches

    Included Quiz Questions

    1. A good sleep regimen, exercise and adequate hydration
    2. Yoga and use of fresh juices
    3. 12 hours of daily sleep
    4. Increasing carbohydrates in the diet
    5. Prophylactic exposure to loud noises and lights.
    1. Cluster headache
    2. Tension Headache
    3. Migraine
    4. Stressed headache
    5. Hypertension headache
    1. Tension-type headache
    2. Cluster headache
    3. Migraine
    4. Vasculitis-induced headache
    5. Aneurysm-induced headache
    1. Migraines are only unilateral in young children.
    2. 50% of the patients are under 20 years of age
    3. A psychosocial stressor can trigger migraine
    4. Migraines in infants can present with pallor
    5. Migraines worsen with activity
    1. May result in temporary neurological deficits
    2. May be associated with severe vomiting
    3. May last up to 3 days
    4. Bitemporal
    5. May be triggered by psychosocial stress
    1. Phenytoin
    2. Hydration and sleep
    3. Promethazine
    4. Sumatriptan
    5. Ibuprofen
    1. Trigeminal distribution
    2. Diffuse location
    3. Unclear mechanism
    4. Lasts 30 min to 7 days
    5. Non-throbbing
    1. Cluster headache
    2. Tension-type headache
    3. Migraine
    4. Aneurysm-induced headache
    5. Vasculitis-induced headache

    Author of lecture Migraines and Headaches in Children

     Brian Alverson, MD

    Brian Alverson, MD

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    Excellent lecture
    By Jalil Z. on 24. July 2020 for Migraines and Headaches in Children

    I particularly liked the table with the difference in headaches with age. Very useful!