Management of Childhood Headache in the Emergency Department. Review of the Literature

Abstract

Headache is the third cause of visits to pediatric emergency departments (ED). According to a systematic review, headaches in children evaluated in the ED are primarily due to benign conditions that tend to be self-limiting or resolve with appropriate pharmacological treatment. The more frequent causes of non-traumatic headache in the ED include primitive headaches (21.8–66.3%) and benign secondary headaches (35.4–63.2%), whereas potentially life-threatening (LT) secondary headaches are less frequent (2–15.3%). Worrying conditions include brain tumors, central nervous system infections, dysfunction of ventriculo-peritoneal shunts, hydrocephalus, idiopathic intracranial hypertension, and intracranial hemorrhage. In the emergency setting, the main goal is to intercept potentially LT conditions that require immediate medical attention. The initial assessment begins with an in-depth, appropriate history followed by a complete, oriented physical and neurological examination. The literature describes the following red flags requiring further investigation (for example neuroimaging) for recognition of LT conditions: abnormal neurological examination; atypical presentation of headaches: subjective vertigo, intractable vomiting or headaches that wake the child from sleep; recent and progressive severe headache (<6 months); age of the child <6 years; no family history for migraine or primary headache; occipital headache; change of headache; new headache in an immunocompromised child; first or worst headache; symptoms and signs of systemic disease; headaches associated with changes in mental status or focal neurological disorders. In evaluating a child or adolescent who is being treated for headache, physicians should consider using appropriate diagnostic tests. Diagnostic tests are varied, and include routine laboratory analysis, cerebral spinal fluid examination, electroencephalography, and computerized tomography or magnetic resonance neuroimaging. The management of headache in the ED depends on the patient's general conditions and the presumable cause of the headache. There are few randomized, controlled trials on pharmacological treatment of headache in the pediatric population. Only ibuprofen and sumatriptan are significantly more effective than placebo in determining headache relief.

Impact of the COVID-19 pandemic on the Emergency Department of a tertiary children’s hospital

“…It is important to analyze the reasons for the large (− 64.6%) reduction in the number of subjects with headaches admitted to ED. In the previous years, data literature reported that the more frequent causes of non-traumatic headache in the ED include benign secondary headaches (35.4–63.2%), represented mainly of upper respiratory tract infections, sinusitis and other limited infections and primitive headaches (21.8–66.3%) [ 38 ]. The headache reduction of ED admission can be explained partly by respiratory tract infections, and other communicable diseases decrease, but a recent Italian multicenter survey showed that lifestyle modification represents the main factor impacting the course of primary headache disorders in children and adolescents.…”

Gender Differences in the Relationship Between Sleep Problems and Suicide Attempt in Adolescents

“…Accordingly, future studies may seek to incorporate objective measures of sleep functioning (e.g., actigraphy) and SA. Third, previous studies have shown that physical illnesses, chronic conditions and circadian chronotype are also important predictors of adolescent sleep outcomes with the exception of sleep duration and quality (40,41). Due to the lack of available data, we were unable to adjust for these factors in the current study which may have the effect of obscuring the accurate nature of the relationship between sleep and suicidality, thus, subsequent research should look to include a measure of youth circadian chronotype and physical ailments.…”

Diagnostic and therapeutic aspects of hemiplegic migraine

“…A careful history, followed by an accurate general and neurological examination looking for red flags that suggest the possibility of a secondary headache disorder or an underlying cause of hemiparesis are necessary. 70 Central nervous system infections may also cause a clinical picture similar to HM with fever and impaired consciousness. CSF analysis and neuroimaging usually allow a clear distinction between the two conditions.…”

“…A careful history, followed by an accurate general and neurological examination looking for red flags that suggest the possibility of a secondary headache disorder or an underlying cause of hemiparesis are necessary. 70 …”