1 / 15

Pediatric Headaches

Pediatric Headaches. Pediatric Pain Resource Nurse Curriculum. Pediatric headache: prevalence and classification. Etiology dictates treatment plan If unknown cause, goal is pain relief or reduction 60% of children experience a headache in a 3 month period 4% of preschoolers

morrison
Télécharger la présentation

Pediatric Headaches

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pediatric Headaches • Pediatric Pain Resource Nurse Curriculum

  2. Pediatric headache: prevalence and classification Etiology dictates treatment plan If unknown cause, goal is pain relief or reduction • 60% of children experience a headache in a 3 month period • 4% of preschoolers • 10% of school-aged children (girls 1:1 boys) • >16% of adolescents (more girls 3:1 boys) • 17% reporting severe headache in the last year • Headache classification • Primary • Secondary

  3. Headache evaluation In addition to obtaining a thorough comprehensive pain history, determine: • Is this the first evaluation? • Has the child already been diagnosed with migraines but there had been a sudden change? • Is the child able to play during the headache? • Is the headache getting less responsive to treatment? • Are there any known triggers of headache? • Are there associated symptoms?

  4. Headache evaluation • Red flags: when to worry • Awakens child • Onset: sudden, abrupt, split-second (thunderclap) • Neurologic symptoms or abnormal findings • Worse when lying down, coughing, Valsalva • Recurrent, localized • Lasting more than 6 months • Systemic symptoms (fever, weight loss) • Previous headache history or headache progression

  5. Marla • Marla is a 10-year-old girl who presents to the ED with what she reports as the worst headache ever. • Has had headaches; treated with ibuprofen and rest • No recent injury or environment/school changes • How will you assess Marla’s headache symptoms?

  6. Migraine • An inherited, chronic disorder with episodic attacks • Children 3-7y (1-3%), Adolescents (8-23%) • More common in girls than in boys • Focus treatment on prevention to reduce frequency and severity of headaches • Types of migraines • Status migrainous • Migraine with aura • Migraine without aura

  7. Treatment plan for migraines • Manage Triggers • Stress • Fatigue • Illness • Fasting • Dehydration • Food • Use Pharmacologic Treatment • Abortive: NSAIDS, Triptans, Opioids • Preventative: Cyproheptadine, Antiepileptics, Tricyclic antidepressants Consider Neutraceuticals

  8. Other headaches • Tension-type headache • Most common type of primary headache • Headache lasting 30 min to 7 days • May be episodic or chronic • Not accompanied by nausea, vomiting, photophobia or phonophobia • Chronic daily headache • Primary HA ≥ 15days per month lasting >4hours • Prevalence in children unknown • Four types: Chronic migraine, Chronic tension type headache, New daily persistent headache, Hemicrania continua

  9. Long-term goals for managing headache pain • Reduce frequency • Reduce reliance on ineffective acute medications • Improve quality of life • Balance biobehavioral with pharmacology • Biobehavioral treatments include: • Stress management • Sleep hygiene • Exercise • Dietary modifications

  10. SMART headache management

  11. Secondary Headaches

  12. Biobehavioral headache management

  13. ? Marla • What questions do you need to ask in order to development an appropriate treatment plan? • Headache started upon waking, vomiting • Keeps head covered, bothered by lights • Felt weird last night, no visual symptoms • Headache worse with movement and lying down • Doing well in school; rewarded with coffee drink

  14. Marla • Case summary • Work-up was negative • Patient improved with hydration, ketorolac • Discussed triggers • Reviewed rescue plan: naproxen, rizatriptan • Discussed SMART headache management • Shared video as part of education • Migraine: How it works and how to get it under control (7:30) • Marla’s treatment plan: • Workup • Triggers • Rescue plan

  15. In Summary

More Related