Life-Threatening Headaches in Children: Clinical Approach and Therapeutic Options

Dalvi, Nagma; Sivaswamy, Lalitha

doi:10.3928/19382359-20180129-04

Cited by 3 publications

(4 citation statements)

References 31 publications

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“…This is particularly relevant for a thunderclap headache (more frequent in adults), which warrants rigorous evaluation to exclude a secondary cause. Any headache with a very rapid onset reaching peak intensity in <1 min is, by definition, a headache of thunderclap onset and can be a symptom of a subarachnoid hemorrhage, hemorrhagic stroke, reversible cerebral vasoconstriction syndrome, venous sinus thrombosis, or even pituitary apoplexy (38). The more gradual onset of neurological symptoms in migraineurs, usually >5 min, is attributed to the cortical spreading depression of Leao, consisting of depolarization followed by hyperpolarization, at a speed of 3–5 mm per min, across the cerebral cortex (39).…”

Section: Primary Headachementioning

confidence: 99%

“…Various conditions can be associated with TCH including: leaking intracranial aneurysm; cervical arterial dissection; venous sinus thrombosis; reversible cerebral vasoconstriction syndrome; pituitary apoplexy; posterior reversible encephalopathy; hypertensive crisis; spontaneous intracranial hypotension. Very rarely, TCH may represent a primary form but a diagnosis can be made only after other etiologies have been excluded by appropriate investigations such as computed tomography (CT) angiography (CTA), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), magnetic resonance venography, and cerebrospinal fluid evaluation (38).…”

Section: Secondary Headachesmentioning

confidence: 99%

“…Infections of the central nervous system must always be suspected in case of a patient with headache, systemic symptoms (in particular fever) and altered consciousness (38, 62). Photophobia and neck stiffness are frequent symptoms in children with meningitis.…”

Section: Secondary Headachesmentioning

confidence: 99%

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Management of Childhood Headache in the Emergency Department. Review of the Literature

et al. 2019

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Headache is the third cause of visits to pediatric emergency departments (ED). According to a systematic review, headaches in children evaluated in the ED are primarily due to benign conditions that tend to be self-limiting or resolve with appropriate pharmacological treatment. The more frequent causes of non-traumatic headache in the ED include primitive headaches (21.8–66.3%) and benign secondary headaches (35.4–63.2%), whereas potentially life-threatening (LT) secondary headaches are less frequent (2–15.3%). Worrying conditions include brain tumors, central nervous system infections, dysfunction of ventriculo-peritoneal shunts, hydrocephalus, idiopathic intracranial hypertension, and intracranial hemorrhage. In the emergency setting, the main goal is to intercept potentially LT conditions that require immediate medical attention. The initial assessment begins with an in-depth, appropriate history followed by a complete, oriented physical and neurological examination. The literature describes the following red flags requiring further investigation (for example neuroimaging) for recognition of LT conditions: abnormal neurological examination; atypical presentation of headaches: subjective vertigo, intractable vomiting or headaches that wake the child from sleep; recent and progressive severe headache (<6 months); age of the child <6 years; no family history for migraine or primary headache; occipital headache; change of headache; new headache in an immunocompromised child; first or worst headache; symptoms and signs of systemic disease; headaches associated with changes in mental status or focal neurological disorders. In evaluating a child or adolescent who is being treated for headache, physicians should consider using appropriate diagnostic tests. Diagnostic tests are varied, and include routine laboratory analysis, cerebral spinal fluid examination, electroencephalography, and computerized tomography or magnetic resonance neuroimaging. The management of headache in the ED depends on the patient's general conditions and the presumable cause of the headache. There are few randomized, controlled trials on pharmacological treatment of headache in the pediatric population. Only ibuprofen and sumatriptan are significantly more effective than placebo in determining headache relief.

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Section: Primary Headachementioning

confidence: 99%

Section: Secondary Headachesmentioning

confidence: 99%

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Management of Childhood Headache in the Emergency Department. Review of the Literature

et al. 2019

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“…After a search in multiple electronic databases, we were unable to find any for secondary headaches in children in either language. With that in mind, we designed the following in Spanish: PPIENSENLo: (“Think about it,” in English), which stands for: P – Patrón clínico diferente/(Change in the clinical pattern) P – Postural, aparece o empeora con cambios de postura del cuerpo/(Postural: appearing/worsening with changes in body posture) I – Inmediato (dolor máximo desde el inicio)/(Immediate, maximum pain from the beginning) E – Evolución menor de 6 mese/(Evolution time less than 6 months) N – Nocturna, lo despierta del sueño o presente al despertar/(Nocturnal; it wakes the patient or is present upon awakening) S – Sistémicos, signos/síntomas (fiebre, escalo‐fríos, pérdida de peso)/(Systemic signs: fever, weight loss, tachycardia, chills) E – Edad menor a 3 años/(Age under 3 years) N – Neurosignos/neurosíntomas (incluyendo papiledema)/(Neurosymptoms/neurosigns, including papilledema) Lo – Localizada y recurrente/(Localized and recurrent) …”

mentioning

confidence: 99%

PPIENSENLo: A Novel Mnemonics in Spanish for Alarm Criteria in Secondary Headaches in Children

2018

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We present the first mnemonic in Spanish, "PPIENSENLo," for alarm criteria in secondary headaches in children in order to facilitate their identification, diagnosis, and treatment. A search was performed across different electronic databases for a mnemonics that applied to clinical alarm criteria in secondary headaches in children. None were found in English or Spanish. This tool is perhaps useful both for clinical and teaching purposes.

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Uncommon Pediatric Primary Headache Disorders

Victorio¹

2018

Pediatr Ann

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Migraine and tension-type headaches are common primary headache disorders encountered among children and adolescents presenting to a pediatric clinic. At times, children present with a headache with unusual or peculiar features that can be alarming and perplexing. These can be in the form of a brief stabbing headache with lacrimation in one eye or a continuous headache locked to one side of the head or face. These headache syndromes tend to be more common among adults but, on occasion, are known to occur or have their onset during childhood. This review outlines some of the uncommon primary headache disorders in children and adolescents that may be encountered in a pediatric clinic. Knowledge of these interesting conditions may avert the need for immediate neurological consultation and prevent delays in initiating specific therapy. [Pediatr Ann. 2018;47(2):e69-e73.].

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Life-Threatening Headaches in Children: Clinical Approach and Therapeutic Options

Cited by 3 publications

References 31 publications

Management of Childhood Headache in the Emergency Department. Review of the Literature

Management of Childhood Headache in the Emergency Department. Review of the Literature

PPIENSENLo: A Novel Mnemonics in Spanish for Alarm Criteria in Secondary Headaches in Children

Uncommon Pediatric Primary Headache Disorders

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