Headache

• Tension headache
• Pseudotumor cerebri
  –Elevated ICP with no masses or abnormalities in CSF or labs
• Cluster headache
  –Unilateral nonthrobbing, periorbital pain
  –May have ipsilateral conjectival injection, lacrimation, rhinorrhea
• Subarachnoid hemorrhage
  –Sudden paroxysmal headache
  –Meningeal signs
  –An emergency requiring CT and LP
• Increased intracranial pressure
  –Tumor, abscess, hydrocephalus, hemorrhage
• Sinusitis, otitis
• Dental disease
• Systemic infection
• TMJ disease
• Postconcussive syndrome
• Trigeminal neuralgia
• Mitochondrial disorders
• Venous sinus thrombosis
• Meningitis/encephalitis
• CSF leak, post-lumbar puncture
• Hypertensive crisis
• Trauma
• Arteriovenous malformation
• Stroke
• Toxins and medication
  –Nitrites, cocaine, interferon, CO
• Fever
• Anemia

Workup and Diagnosis

• History
  –Duration (recurrent, progressive), frequency
  –Time of onset and duration
  –Location and nature of pain, warning (aura)
  –Factors that alleviate or exacerbate symptoms (e.g., stress)
  –Nausea, vomiting, photophobia, phonophobia
  –Family history, response to treatment
• Physical exam
  –Vital signs (temperature, blood pressure)
  –Height, weight, head circumference
  –Funduscopy (to rule out papilledema)
• Neuroimaging (CT, MRI) is required for certain symptoms
  –Short history of headache (<6 months) or age <5–6 years
  –Worsening headaches, no response to treatment
  –Deterioration in cognitive or motor function
  –Short stature, macrocephaly
  –Awakening at night or early morning
  –Repeated morning vomiting
  –Exacerbation by position change or cough
  –Focal neurologic symptoms during headache
  –Cluster headache in prepubertal children and adolescent girls
  –Systemic symptoms: Fatigue, weight loss
  –Abnormal neurological exam
  • Lumbar puncture with opening pressure
    –Subarachnoid hemorrhage, pseudotumor, or meningitis

  Treatment

  • Explanation and reassurance alone may provide relief
  • Avoid triggers
    –Trauma, sunlight, insomnia, stress, diet, dehydration
  • Symptomatic treatment:
    –Acetominophen, NSAIDs, Midrin, Fioricet, Fiorinal
    –Selective serotonin-1 receptor agonists
    –Dihydroergotamine (DHE); Migranal nasal spray
    –Antiemetics
  • Prophylaxis
    –NSAIDs, β-blockers, tricyclic antidepressants, cyproheptadine, calcium channel blockers, antiepileptic drugs, biofeedback
    • Cluster headaches
      –Treated with inhalation of oxygen; sumatriptan
    • Pseudotumor
      –Weight reduction, Diamox
      –Optic nerve sheath decompression or shunting
    >>

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Earache

Read excerpts from these other book chapters related to Earache:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Earache

• Back to symptom: Earache: Introduction (review 186 causes)
• Next Book Extract About Earache: Otalgia (Ear Pain) (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Earache

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: Otalgia (Ear Pain) (In A Page: Pediatric Signs and Symptoms)

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