Headache

Authors: Flaherty, Alice W.; Rost, Natalia S.

Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition

Copyright 2007 Lippincott Williams & Wilkins

> Table of Contents > Child Neurology > Headache

Headache

A. See also

Adult Headache, p. 52; Concussion, p. 119; Ophthalmoplegic migraine, p. 136.

B. H&P

How much school is missed? Does the HA stop pt from playing or watching TV? Visual changes? Very young children may have only paroxysmal vomiting with or without paroxysmal vertigo. Check for stiff neck, papilledema, head circumference, tooth and ear infection, cerebral bruits (common, but should not be asymmetric), heart murmur.

C. Causes

see p. 52. In very young children, consider also occipital seizures (rare).

D. Tests

No need for MRI in pts with stable recurrent HA >6 mo and normal neuro exam including fundi.

P.141

E. Rx of migraine

Similar to adults.

• Acute rx: Consider an NSAID + promethazine (Phenergan) 1 mg/kg PO. Sumatriptan has been safely used in school-aged children; divide the dose in half for smaller ones.

• Prophylaxis: For children with >2-3 significant HAs/mo. Try propranolol 0.5-1.0 mg/kg bid (asthma, DM, and depression are contraindications) or cyproheptadine 2-4 mg PO bid-tid. Consider also nortriptyline (monitor serum level and QT interval) or valproate 15-45 mg/kg/d age 7-16; 500-1,000 mg/d age 9-17.