Post on 18-Dec-2015
transcript
Sue Lipscombe
Brighton GP
Sue Lipscombe
Brighton GP
Children’s Headaches0-18?
Children’s Headaches0-18?
SINISTER and SECONDARYHEADACHESSINISTER and SECONDARYHEADACHES
Less than 5% of children’s headaches are serious disease or due to physical problems
Fever – common cause of headaches Occasionally meningitis but never recurrent Head Trauma causes pain at time and site of
trauma, lingering headache is worry Sinus infection, TMJ, Dental Problems Tests are only necessary if sinister headache is
being considered. They will not diagnose migraine or tension type headaches
Less than 5% of children’s headaches are serious disease or due to physical problems
Fever – common cause of headaches Occasionally meningitis but never recurrent Head Trauma causes pain at time and site of
trauma, lingering headache is worry Sinus infection, TMJ, Dental Problems Tests are only necessary if sinister headache is
being considered. They will not diagnose migraine or tension type headaches
CHILDREN MAY BE TOO YOUNG TO DESCRIBE THEIR HEADACHES
CHILDREN MAY BE TOO YOUNG TO DESCRIBE THEIR HEADACHES
BUT they may draw them Every picture tells a story Parents may try to get child to draw headache as
soon as the child feels better so it remains fresh in their mind
Your doctor may want your child to tell their own story so please try and encourage them to talk. Parents/ carers will be able to add their own helpful thoughts later.
BUT they may draw them Every picture tells a story Parents may try to get child to draw headache as
soon as the child feels better so it remains fresh in their mind
Your doctor may want your child to tell their own story so please try and encourage them to talk. Parents/ carers will be able to add their own helpful thoughts later.
Parents can act as observersParents can act as observers
Watch how the child looks Do they look pale and ill? Do they stop eating? Do they carry on with activities? Do they choose to lie down? Do they recover rapidly? What do they do with their hands?
Watch how the child looks Do they look pale and ill? Do they stop eating? Do they carry on with activities? Do they choose to lie down? Do they recover rapidly? What do they do with their hands?
Watch Hand GesturesWatch Hand Gestures
Headache can start youngHeadache can start young
Even babies and toddlers may have headaches 6 years old (in preceding 6mth period)
16 % of children
12 years old (in preceding 6months) 19 % of children
Even babies and toddlers may have headaches 6 years old (in preceding 6mth period)
16 % of children
12 years old (in preceding 6months) 19 % of children
Migraine can start youngMigraine can start young
Migraine grows from infrequent to frequent:
6 years old 2% 10 years old 6% 18 years old 10%
Many (65 - 90%) not problematical: infrequent, short, familiar
Migraine grows from infrequent to frequent:
6 years old 2% 10 years old 6% 18 years old 10%
Many (65 - 90%) not problematical: infrequent, short, familiar
Development migraine over timeDevelopment migraine over time
Before puberty: boys = girls After puberty: more girls
Luckily 35%: Migraine disappears 8 > 13 yrs But: 12 % of migraine children develop severe
migraine eventually > prophylactics
Duration attack increases with age 8 yrs: duration 1-2 hrs 15 yrs: duration > 2 hrs
Before puberty: boys = girls After puberty: more girls
Luckily 35%: Migraine disappears 8 > 13 yrs But: 12 % of migraine children develop severe
migraine eventually > prophylactics
Duration attack increases with age 8 yrs: duration 1-2 hrs 15 yrs: duration > 2 hrs
Associated (risk)factors-1Associated (risk)factors-1
Parents and siblings with headache Unhappiness in the family Low SES-status (tension-type, but no relation with
migraine) Depression (tension-type) More motion sickness (migraine) More abdominal (migraine) Other pains (tension-type)
Parents and siblings with headache Unhappiness in the family Low SES-status (tension-type, but no relation with
migraine) Depression (tension-type) More motion sickness (migraine) More abdominal (migraine) Other pains (tension-type)
Diagnosis migraine; differences with adults
Diagnosis migraine; differences with adults
Children
Migraine in ‘family’ useful
Duration 2-72 (2-12 usually)
Often 1-2 hrs in young children
Often bilateral headache
Occipital headache rare &
alarming
Sleep frequently helps
Children
Migraine in ‘family’ useful
Duration 2-72 (2-12 usually)
Often 1-2 hrs in young children
Often bilateral headache
Occipital headache rare &
alarming
Sleep frequently helps
Adults
Family history not so helpful
Duration 4-72 (4-36 usually)
If < 2 hrs no migraine
Unilateral headache common
Occipital headache common
and not alarming
Disturbs sleep
Adults
Family history not so helpful
Duration 4-72 (4-36 usually)
If < 2 hrs no migraine
Unilateral headache common
Occipital headache common
and not alarming
Disturbs sleep
What to do: tension-type headacheWhat to do: tension-type headache
Explanation, reassurance “It is one of those common pains, a
nuisance rather than a problem” Recognising benign pattern with diary
Explanation, reassurance “It is one of those common pains, a
nuisance rather than a problem” Recognising benign pattern with diary
What to do: tension-type headache the parents
What to do: tension-type headache the parents
Distraction activities: they help
Lying down not helpful (for headache…)
Keeping diaries is useful for child and parent and doctor
Distraction activities: they help
Lying down not helpful (for headache…)
Keeping diaries is useful for child and parent and doctor
STRESSSTRESS
A MAJOR FACTOR ONE OR TWO HEADACHES MAY
CAUSE STRESS- DEVELOP CDH EXAMINATION STRESS PERFORMANCE STRESS PARENTAL STRESS RELATIONSHIP STRESSES
A MAJOR FACTOR ONE OR TWO HEADACHES MAY
CAUSE STRESS- DEVELOP CDH EXAMINATION STRESS PERFORMANCE STRESS PARENTAL STRESS RELATIONSHIP STRESSES
What to do: tension-type headachereferrals
What to do: tension-type headachereferrals
Training in optimal posture and excercises is more an adult thing optional for youngsters and adolescents ‘Therapy’ is boring and they are right Children should play, not do fitness training
Sport is a child thing but can be dancing or other diverting exercise
Training in optimal posture and excercises is more an adult thing optional for youngsters and adolescents ‘Therapy’ is boring and they are right Children should play, not do fitness training
Sport is a child thing but can be dancing or other diverting exercise
What to do: tension-type headachereferrals
What to do: tension-type headachereferrals
The person of the physiotherapist is more important than the therapy itself Encourage to start a sport Change towards more activity Rarely medication
Though: careful manipulation is optional
The person of the physiotherapist is more important than the therapy itself Encourage to start a sport Change towards more activity Rarely medication
Though: careful manipulation is optional
What to do: migrainethe parents
What to do: migrainethe parents
Rest, quiteness, let the child alone Lying down is very helpful Children ‘sleep migraine out of their head’ Being a tough child is not helpful Inform teachers, friends: same approach Try and avoid triggers Travel sickness is a pointer
Rest, quiteness, let the child alone Lying down is very helpful Children ‘sleep migraine out of their head’ Being a tough child is not helpful Inform teachers, friends: same approach Try and avoid triggers Travel sickness is a pointer
What to do: migrainethe parents
What to do: migrainethe parents
Sleep hygiene is very effective After 6 months fewer attacks Shorter attacks
Regulate or stop caffeine intake Food triggers usually obvious but try groups
rather than individual foods It may make the child introspective if it isn’t
obvious
Sleep hygiene is very effective After 6 months fewer attacks Shorter attacks
Regulate or stop caffeine intake Food triggers usually obvious but try groups
rather than individual foods It may make the child introspective if it isn’t
obvious
Prevention is better than curePrevention is better than cure
Try and avoid any obvious triggers Each child is an individual and needs
individual care Parents may recognise triggers that the child
misses The child should always be part of
discussion for many reasons
Try and avoid any obvious triggers Each child is an individual and needs
individual care Parents may recognise triggers that the child
misses The child should always be part of
discussion for many reasons
What to do: migrainemedication
What to do: migrainemedication
In time, high dosage of minor pain medication, NSAID’s, and/or anti-emetics Similar to adults Parents tend to under-dose a child Often the attack is too short to treat
Triptans are allowed now from 12 yrs old: nasal spray
In time, high dosage of minor pain medication, NSAID’s, and/or anti-emetics Similar to adults Parents tend to under-dose a child Often the attack is too short to treat
Triptans are allowed now from 12 yrs old: nasal spray
What to do: migrainemedication
What to do: migrainemedication
Prophylactics : > 3 attacks a month Betablockers (valproate) Pizotifen - sanomigran
Stop after 6 – 12 months Start again if the attack frequency recurs,
but often this is unnecessary
Prophylactics : > 3 attacks a month Betablockers (valproate) Pizotifen - sanomigran
Stop after 6 – 12 months Start again if the attack frequency recurs,
but often this is unnecessary
Behavioural problems Behavioural problems
Are they sometimes caused by headache? Are they sometimes caused by headache?
PARENTSPARENTS
Keep diary of headache frequency Keep diary of headache severity Keep diary of foods Keep diary of events Keep diary of medication Keep diary of stresses Keep diary of sleep
Keep diary of headache frequency Keep diary of headache severity Keep diary of foods Keep diary of events Keep diary of medication Keep diary of stresses Keep diary of sleep
REMEMBERREMEMBER
Diagnosis is made by the history Blood tests are rarely necessary Brain scans are scary, dangerous and
usually not necessary Usually the longer the history the less likely
the headache is to be sinister.
Diagnosis is made by the history Blood tests are rarely necessary Brain scans are scary, dangerous and
usually not necessary Usually the longer the history the less likely
the headache is to be sinister.
The change we need to effect
QUESTIONS?QUESTIONS?
AND THANK YOU FOR LISTENING AND WORKING
WITH DOCTORS TO HELP YOUR CHILD
AND THANK YOU FOR LISTENING AND WORKING
WITH DOCTORS TO HELP YOUR CHILD