Pediatric Headache: A Primer for the Non-Neurologist · “Pediatric Headache: A Primer for the Non-Neurologist” Anne Marie Morse, DO POMA 111th Annual Clinical Assembly & Scientific

“Pediatric Headache: A Primer for the Non-Neurologist”Anne Marie Morse, DO

POMA 111th Annual Clinical Assembly & Scientific SeminarMay 1-4, 2019

1

Pediatric Headache:

A Primer for the Non-NeurologistAnne Marie Morse, DO

Clinical Associate Professor, GCSOM

Geisinger Medical Center

Janet Weis Children’s Hospital

Child Neurology

Sleep Medicine

2

Conflict of Interest Disclosures for Speakers

1. I do not have any relationships with any entities producing, marketing, re-selling, or distributing health care goods or

services consumed by, or used on, patients, OR

X 2. I have the following relationships with entities producing, marketing, re-selling, or distributing health care goods or services

consumed by, or used on, patients.

Type of Potential Conflict Details of Potential Conflict

Grant/Research Support The Klarman Foundation, NIH, Avadel Pharmaceutical

Consultant Jazz Pharmaceuticals

Speakers’ Bureaus Jazz Pharmaceuticals

Financial support

Other

X 3. The material presented in this lecture has no relationship with any of these potential conflicts, OR

4. This talk presents material that is related to one or more of these potential conflicts, and the following objective references

are provided as support for this lecture:

1.

2.

3.

#POMA19 #ChooseKnowledge

6

Case 1:

JR is a 10 year old boy presenting for initial evaluation of headache

Headaches started at 7 years old. They are described as holocephalicthrobbing pain. They are associated with nausea and vomiting, photophobia and phonophobia. They occur 5-7 days a month. He has missed 4 days of school in the last 3 months related to HA. Mother gives him Tylenol liquid 5 ml when he has a headache. She is concerned that his headaches don’t get better with medication, but sleep can help.

Thoughts?


1

2

6



7

Primary Headache

➢ Definition: headache that is due to the condition itself

and not due to another cause

➢ Statistics:

➢Children ages 3-7 years → 3%

➢Adolescents ages 11-15 years → 8% to 23%

➢ Examples:

➢Migraine

➢TTH

➢Chronic Daily Headache




7

8

9



10

If you only had

5 questions to

ask…

1. When did you first get

headaches?

2. Describe the headaches.

3. Modifying factors (better/worse)

4. Disability

5. Red Flag Signs or Symptoms


11

Case 2:

JR is a 10 year old boy presenting for initial evaluation for headache.

Headaches started 2 weeks ago. They are severe occipital/cervical pressure type headaches that wake him from sleep. There is associated complaints of nausea/vomiting. There is some photophobia and phonophobia. He complains of diplopia and mother endorses that he seems more clumsy than usual.

Thoughts?


12

10

11

12






Approach to Treatment



13

14

15



Quantify and Qualify



17

Headache Start

Date/Time

Describe what

happened before

the headache

How bad was the

pain?

(0-10)

Where did your

head hurt?

What did you feel

before and during

the headache?

What did you try to

make yourself

better?

Did you feel

better?

Headache End

Date/Time

Where Does it

Hurt?

Date of your last menstrual period:

______________________________


Behavioral Therapy



16

17

18



19Faedda, N., Cerutti, R., Verdecchia, P., Migliorini, D., Arruda, M. and Guidetti, V., 2016.

Behavioral management of headache in children and adolescents. The journal of headache

and pain, 17(1), p.80.

20#POMA19 #ChooseKnowledge

21

Cognitive Behavioral Therapy

➢ CBT is beneficial to children suffering from migraine, and may also augment the efficacy of standard medications such as amitriptyline

➢ Improvement seen can be persistent (even at 1-year follow-up)

➢ CHAMP Study Results

➢ comparative effectiveness study of amitriptyline, topiramate, and placebo for the prevention of migraine


19

20

21





Medications



22

23

24






25

26

27



28

Case 3

A 15-year-old female presents to your office with eight headaches per month over the last 6 months that typically last hours to 1 day. The headache is described as bifrontal, throbbing, and severe, with associated light sensitivity and nausea. She denies vision changes or other neurologic symptoms with headaches. She states that her headaches typically resolve with use of OTC pain relievers and she will also lie down in her room with the lights off and sleep. She has a past medical history notable for motion sickness, and there is a family history of maternal relatives with headaches attributed to sinusitis. Her neurologic examination is non-focal.


29

Case 4

An 11-year-old boy presents to the emergency department after he collapsed while running outside following the sudden onset of “the worst” headache of his life associated with vomiting and neck pain. There was no witnessed head trauma. On examination, the boy is afebrile, though noted to be lethargic and difficult to arouse with photophobia and neck stiffness.


30

Case 5

An 11-year-old boy presents to your office with worsening headaches over the last month. The family denies clear triggers for the headaches, although mentions the patient recently completed end of semester testing at school and one of his best friends moved away. He describes his headaches as bifrontal or diffuse with a squeezing type of pain and phonophobia. He denies photophobia, nausea, vomiting, visual disturbance, or other focal neurologic symptoms with his headaches. The family history is unremarkable. His neurologic examination is non-focal, but notable for neck muscle tension.


28

29

30



31

THANK YOU!

Questions?Email: [email protected]


31

Documents

Pediatric Headache: A Primer for the Non-Neurologist · “Pediatric Headache: A Primer for the Non-Neurologist” Anne Marie Morse, DO POMA 111th Annual Clinical Assembly & Scientific