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Headache is a common problem in pediatrics.
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Headache may occasionally indicate a severe
underlying disorder (e.g. brain tumour) and thus careful evaluation of child
with recurrent, severe or unconventional headache is mandatory.
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Most toddlers cannot communicate the
characteristics of headache but they become irritable, prefer a darkened room
because of photophobia or repeatedly rub their eyes and head.
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Causes of headache in children:
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1- Migraine: is defined as recurrent headache with symptom-free intervals.
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It manifests by: throbbing, bitemporal or
unilateral pain associated with nausea, vomiting, abdominal pain, photophobia
and commonly positive family history of migraine.
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Treatment of migraine:
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- Avoid stress, fatigue
and anxiety.
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- Elimination of
certain foods as nuts, chocolate, and cola drinks, particularly if there is
association between these foods and onset of migraine.
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- Acute attacks: should
be treated by analgesics (acetaminophen, Ibuprofen) and antiemeticsProphylaxis against recurrent attacks:•
By administration of propranolol,
cyproheptadine or antiepileptic drugs, if the attacks are frequent and /or
severe
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2- Tension headache: dull aching, sharp pain, generalized or at the
vertex. It is usually associated with difficult sleep, dizziness, family or
school problems.
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3- Increased intra-cranial tension: commonly bifrontal increases by coughing or
sneezing, associated with persistent vomiting which increases in the morning
and not responds to antiemetics.
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4- Other causes
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a- Hypertension, anemia.
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b- Psychogenic factors or
stress.
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c- Refractive errors and strabismus.
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d- Sinusitis and carries of teeth
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Evaluation of headache by:
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●
Blood pressure measurement.
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● Measuring head size
& teeth examination.
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● Neurological
examination.
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● Ophthalmologic
evaluation for visual acuity & fundus examination.
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● E.N.T. examination.
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● Plain x ray of skull.
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● C.T. brain for
exclusion of intracranial space occupying lesions.
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