Headache in children

Dr. Negi
Dr. Negi
Jul 21, 2017 · 2 min read

Headache is one of the commonest neurological symptoms in children and young people who are referred to doctors. Headache refers to pain involving the orbits, forehead, scalp and temples but not the face or neck.The primary headache includes chronic or recurrent headache and migraine. The prevalence of chronic or recurrent headaches in children occur in 60–69% by the age of 7–9 years and 75% by the age of 15 years. The prevalence of migraine in children is up to 28% of older teenagers. The most serious cause of the secondary headache is brain tumor and the prevalence of brain tumours in children is 3 per 100,000 per annum.

Dealing with patients with headache requires knowledge of different varieties of headaches. Detailed history and clinical examination play a major role in getting the diagnosis right. Neuroimaging is not always needed in primary headache but is often required in secondary headache.

The management of headaches is totally dependent on the diagnosis. Medications used in primary acute headache include paracetamol, ibuprofen, diclofenic, Triptans and, if there is nausea or vomiting, anti-sickness drugs can be used, such as cyclizine or domperidone. Chronic headaches occur 3–4 per month include migraine should be treated with prophylactic drugs. e.g. Propranolol, pizotifen, amitryptline and others prescribed by the specialist. The duration of treatment depend on the response and if no response with maximum dose, diagnosis should be revisited. For migraines with or without aura, sumatriptan and zolmitriptan nasal spray is much better than oral, together with ibuprofen or paracetamol or both. Anti-sickness can be used with these as well.

Acute severe headaches in children requires immediate attention with neuroimaging, admission and perhaps intravenous medication for 24hrs and then a shift to prophylactic if needed.

Medication over-use in chronic and tension headaches is an issue and should be avoided. Stopping all medication abruptly which used to treat headache . Patient can change his/her life style with more relaxation, regular sleep and meals, plenty of fluids and exercise when there is no headache.

Psychological help is important in recurrent and chronic headache and involving a psychologist as early as possible is very important. Referral to the headache clinics can be done early where a multidisciplinary approach is adopted. Any delay in managing headache will create anxiety and stress to parents and considerable discomfort for the child; seeking help from a specialist at an earlier stage is very important.

Dr Nagi Barakat (MBBCH, MRCPCH, Msc epilepsy, CCST, FRCPCS, CASLAT (med. Educ.,PET)

Consultant paediatrician/Neurology

London-UK

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