Headaches in Children: Model Clinical Case and VIva Q&A

Clinical Case of Headaches in Children

Patient: Sarah, 9-year-old female
Chief Complaint: Recurrent headaches for the past 3 months

History of Present Illness:
Sarah, a previously healthy 9-year-old girl, presents to the pediatric clinic with her mother, reporting recurrent headaches over the past 3 months. The headaches occur 2-3 times per week, typically in the afternoon after school. Sarah describes the pain as throbbing, primarily located in the frontal region bilaterally. The pain intensity ranges from 4-7 out of 10 on a pain scale.

Each episode lasts 2-4 hours and is occasionally associated with nausea, but no vomiting. Sarah reports sensitivity to light and sound during these episodes. The headaches often improve with rest in a dark, quiet room. Over-the-counter ibuprofen provides partial relief.

Sarah's mother notes that the headaches seem to worsen during periods of academic stress or when Sarah hasn't slept well. There's no history of head trauma, visual changes, or neurological symptoms. Sarah has missed several days of school due to these headaches.

Past Medical History: Unremarkable
Family History: Mother suffers from migraines
Social History: Lives with both parents and a younger sister. Performs well academically but reports increased stress due to upcoming exams.

Physical Examination:

  • Vital Signs: Within normal limits
  • General: Alert, cooperative, no acute distress
  • HEENT: Normocephalic, atraumatic. No sinus tenderness. Fundi normal.
  • Neurological: Cranial nerves intact. Normal motor and sensory function. No meningeal signs.

Assessment: Suspected migraine headaches in a pediatric patient

Plan:

  1. Educate patient and family about migraine headaches
  2. Recommend lifestyle modifications: regular sleep schedule, stress reduction techniques, and proper hydration
  3. Start a headache diary to identify potential triggers
  4. Prescribe sumatriptan nasal spray for acute attacks
  5. Consider prophylactic therapy if frequency increases
  6. Follow-up in 4 weeks to assess response to treatment
  7. Neuroimaging not indicated at this time given the absence of red flag symptoms


Varieties of Clinical Presentations of Headaches in Children
  1. Migraine without Aura:
    • Recurrent, pulsating headaches lasting 2-72 hours
    • Unilateral or bilateral pain, often frontal or temporal
    • Associated with nausea, vomiting, photophobia, and phonophobia
    • May experience pallor, dizziness, or abdominal pain
  2. Migraine with Aura:
    • Similar to migraine without aura, but preceded by neurological symptoms
    • Visual aura: flickering lights, spots, or lines
    • Sensory aura: numbness or tingling, usually unilateral
    • Rarely, motor weakness or speech disturbances
  3. Tension-type Headache:
    • Bilateral, pressing or tightening sensation
    • Mild to moderate intensity, not aggravated by physical activity
    • No nausea or vomiting, but may have photophobia or phonophobia
    • Often described as a "band-like" pressure around the head
  4. Chronic Daily Headache:
    • Headaches occurring 15 or more days per month for over 3 months
    • Can be a mix of migraine and tension-type headaches
    • Often associated with medication overuse
    • Significant impact on daily activities and quality of life
  5. Cluster Headache:
    • Rare in children, more common in adolescents
    • Severe unilateral pain, often periorbital
    • Associated with autonomic symptoms: conjunctival injection, lacrimation, nasal congestion
    • Attacks occur in clusters, lasting weeks to months, followed by remission periods
  6. Secondary Headaches:
    • Due to underlying conditions such as sinusitis, dental problems, or vision issues
    • Can be caused by intracranial pathologies like tumors or increased intracranial pressure
    • May present with "red flag" symptoms like sudden onset, worsening pattern, or neurological deficits
  7. Abdominal Migraine:
    • Recurrent episodes of moderate to severe abdominal pain
    • Associated with nausea, vomiting, pallor
    • May or may not be accompanied by head pain
    • Typically lasts 1-72 hours


Knowledge Check: Question and Answers for Medical Students & Professionals

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The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.



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