Pain PRN 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 ID: 915406
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Slide1
Pediatric Headaches
Pediatric
Pain PRN Curriculum
Slide2Pediatric 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 period4% of preschoolers10% 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 classificationPrimarySecondary
Slide3Headache 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?
Slide4Headache evaluation
Red flags: when to worry
Awakens child
Onset: sudden, abrupt, split-second (thunderclap) Neurologic symptoms or abnormal findingsWorse when lying down, coughing, ValsalvaRecurrent, localizedLasting more than 6 monthsSystemic symptoms (fever, weight loss)Previous headache history or headache progression
Slide5How will you assess Marla’s headache symptoms?
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
Marla
Slide6Migraine
An inherited, chronic disorder with episodic attacks
Children 3-7y (1-3%),
Adolescents (8-23%)More common in girls than in boysFocus treatment on prevention to reduce frequency and severity of headachesTypes of migrainesStatus migrainousMigraine with auraMigraine without aura
Slide7Treatment plan for migraines
Manage Triggers
Stress
FatigueIllnessFastingDehydrationFoodUse Pharmacologic TreatmentAbortive: NSAIDS, Triptans, OpioidsPreventative: Cyproheptadine, Antiepileptics, Tricyclic antidepressantsConsider Neutraceuticals
Slide8Other headaches
Tension-type headache
Most common type of primary headache
Headache lasting 30 min to 7 daysMay be episodic or chronicNot accompanied by nausea, vomiting, photophobia or phonophobiaChronic daily headachePrimary HA ≥ 15days per month lasting >4hoursPrevalence in children unknownFour types: Chronic migraine, Chronic tension type headache, New daily persistent headache, Hemicrania continua
Slide9Long-term goals for managing headache pain
Reduce frequency
Reduce reliance on ineffective acute medications
Improve quality of lifeBalance biobehavioral with pharmacologyBiobehavioral treatments include:Stress management Sleep hygieneExerciseDietary modifications
Slide10SMART headache management
S
Regular and sufficient sleep
MRegular and sufficient meals and hydrationA
Regular aerobic exerciseRRelaxation and stress reductionTTrigger avoidance
Slide11Secondary Headaches
Slide12Biobehavioral headache management
Slide13What 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 symptomsHeadache worse with movement and lying downDoing well in school; rewarded with coffee drink
Marla
?
Slide14Marla’s treatment plan:
Workup
Triggers
Rescue planCase summaryWork-up was negativePatient improved with hydration, ketorolacDiscussed triggersReviewed rescue plan: naproxen, rizatriptanDiscussed SMART headache management
Shared video as part of educationMigraine: How it works and how to get it under control (7:30)
Marla
Slide15In Summary