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