Dr. Moodley: Headaches in Children - Cleveland Clinic

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Diagnosis Good case contd Migraine without aura Neurological Examination Red Flags Balance difficulty Seizures or abnormal movements Altered level of consciousness Abnormal eye movements Abnormal fundoscopic findings Any neurologic abnormalities The Good A Case Study An 11 y/o girl has HA twice monthly, for the past 8 months. There is no aura. She is pale. She goes to her room, shuts off the lights and the television, and refuses her usual snack. She is nauseated and sleeps. She is better in 3 hours. There are no neurological symptoms. Family history of migraine. She is an “A” student, does not miss school, and does not overuse OTC medication. Her physical and neurological examinations are normal. Migraine: Goals of Treatment Reduction of headache severity, frequency, duration and disability Avoidance of acute/chronic excessive medication Improvement of quality of life “Normalization”
None Migraine: Treatment Non pharmacological Acute – symptomatic Abortive Preventive Combinations Migraine: Symptomatic Treatment Nausea and Vomiting Promethazine Metaclopramide Ondansetron Pain Migraine: Symptomatic Treatment NSAIDS Ibuprofen Naproxen Acetaminophen Migraine: Non-Pharmacological Non Pharmacological Approaches Confident reassurance Patient/parent education Diary Trigger avoidance stress/sleep/diet Environment cool/quiet/dark/cold compress School attendance Relaxation/biofeedback/counseling Sedation Migraine: Symptomatic Treatment Diphenhydramine Cyproheptadine Benzodiazepine Migraine: Abortive Treatment None are FDA approved in children and adolescents Ergotamine- DHE Triptans Imitrex Zomig
Page 1 and 2: Headaches in Children Manikum Moodl
Page 3: History Red Flags First and worst
Page 7 and 8: The Ugly A Case Study A 14 y/o gir

Dr. Moodley: Headaches in Children - Cleveland Clinic

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