25.11.09

answer to the saudi medical council question examination

Headaches in children
By Mayo Clinic staff
Original Article:http://www.mayoclinic.com/health/headaches-in-children/DS01132
Definition

Headaches in children are common and are usually not serious. Like adults, children can develop migraines, chronic daily headaches or stress-related (tension) headaches, although their symptoms may be different.

In some cases, headaches in children are caused by an infection, high levels of stress or anxiety, or minor head trauma. That's why it's important to pay attention to your child's headache symptoms and to consult a doctor if the headache worsens or occurs frequently. Headaches in children can usually be treated with over-the-counter pain medications and other lifestyle and home measures.
Symptoms

Children get the same types of headaches that adults do, although their symptoms may be different. For example, a migraine in an adult almost always affects just one side of the head, whereas a child's migraine often affects both sides of the head. Also, migraines in children typically don't last as long.

Migraine
Migraines can cause:
Head pain
Nausea
Vomiting
Abdominal pain
Extreme sensitivity to light and sound

Even infants can have migraines. A child who's too young to tell you what's wrong may cry and hold his or her head to indicate severe pain. Migraines in children may last an hour or more.

Tension-type headache
Often, stress related, tension-type headaches feature a pressing tightness that occurs on both sides of the head. They can last from 30 minutes to several days.

Chronic daily headache
Both migraines and tension-type headaches can begin happening more frequently. If your child has headaches more than 15 days a month for more than three months, doctors call this a "chronic daily headache." This problem can occur when your child takes pain medications ? even the nonprescription variety ? too frequently.

Cluster headache
This is the least common type of headache in children. It's usually disabling and involves a sharp, stabbing pain on one side of the head that lasts less than three hours.

When to see a doctor
Seek a doctor's advice if your child's headaches:
Occur at least once a month
Follow an injury, such as a blow to the head
Feature persistent vomiting or visual changes
Are accompanied by fever, along with neck pain or stiffness
Causes

A number of factors, singly or in combination, can make your child headache-prone. These factors include:
Genetic predisposition. Headaches, particularly migraines, tend to run in families. If you have a family history of migraines, your child will have a higher risk of getting them too.
Head trauma. Accidental bumps and bruises can cause headaches. Although most head injuries are minor, seek medical attention right away if your child falls hard on his or her head. Also contact a doctor if your child has a steadily worsening head pain after a head injury.
Illness and infection. Headache is a frequent symptom of many common childhood illnesses. Ear infections, sinus infections, colds and flu are often accompanied by headache.
Environmental factors. Conditions in the environment, including weather changes, can cause headaches.
Emotional factors. High levels of stress and anxiety ? often triggered by problems with peers, teachers or parents ? can play a role in many children's headaches. Children with depression may complain of headaches, particularly if they have trouble recognizing feelings of sadness and loneliness.
Certain foods and beverages. The food additive monosodium glutamate (MSG), found in such foods as bacon, bologna and hot dogs, has been known to trigger headaches. Also, caffeine, which is in soda, chocolate, coffee and tea, can cause headaches.
Risk factors

Any child can develop headaches, but they're more common in:
Children older than 10
Boys before they reach puberty
Girls after they reach puberty
Children who have a family history of headaches or migraines
Preparing for your appointment

For headaches in children, you typically make an appointment with your family doctor or your child's pediatrician. Depending on the frequency and severity of your child's symptoms, you may be referred to a doctor who specializes in conditions of the brain and nervous system (neurologist).

Because appointments can be brief and there's often a lot of ground to cover, it can help to be well prepared. Here are some tips to help you get ready for your child's appointment and what to expect from the doctor.

What you can do
Write down your child's signs and symptoms, when they occurred and how long they lasted. It may help to keep a headache diary ? listing each headache, when it happens, how long it lasts, and what might have caused it.
Make a list of all medications, as well as any vitamins or supplements, that your child is taking.
Write down questions to ask your doctor. Don't be afraid to ask questions or to speak up when you don't understand something your doctor says.

List your questions from most important to least important in case your time with your doctor runs out. For headaches in children, some basic questions to ask your doctor include:
What is likely causing the symptoms?
Are tests needed to confirm the diagnosis?
What are other possible causes for the symptoms?
Is the condition likely temporary or chronic?
What is the best course of action?
Does my child need prescription medication, or would an over-the-counter medication work?
What kind of follow-up, if any, is needed?
What can we do at home to help lessen the pain?
What can we do at home to prevent headaches?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
When did the symptoms first start?
How often does your child experience these symptoms?
How long does the headache usually last?
Where does the pain occur?
Have the symptoms been continuous or occasional?
Does your child have other symptoms, such as nausea or dizziness?
What, if anything, makes it better?
What, if anything, makes it worse?
Has your child's symptoms changed over time?
What at-home treatments have you tried?
What medications does your child take?
Do other family members experience headaches?

What you can do in the meantime
While waiting for your child's appointment, place a cool, wet cloth on your child's forehead and encourage him or her to take a nap in a dark, quiet room.

Also, consider giving your child over-the-counter pain medications (acetaminophen or ibuprofen) to ease symptoms. Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children. Talk to your doctor if you have concerns.
Tests and diagnosis

The causes of most headaches in children can be found with a little detective work. Your doctor asks you and your child to describe the headaches in detail, to see if there's a pattern or a common trigger. The doctor also performs a physical exam and conducts a neurological exam, which checks for any problems with movement, coordination or sensation.

Blood tests, imaging scans and other evaluations are occasionally needed to pinpoint a diagnosis or to rule out other medical conditions that could be causing the headaches. These tests may include:
Computerized tomography (CT). This imaging procedure uses a series of computer-directed X-rays that provide a cross-sectional view of your child's brain. This helps doctors diagnose tumors, infections and other possible medical problems that may be causing headaches.
Magnetic resonance imaging (MRI). MRIs use radio waves and a powerful magnet to produce very detailed views of your brain. MRI scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.
Spinal tap (lumbar puncture). If your doctor suspects that an underlying condition, such as bacterial or viral meningitis, is the cause of your child's headaches, he or she may recommend a spinal tap (lumbar puncture). In this procedure, a thin needle is inserted between two vertebrae in the lower back to extract a sample of cerebrospinal fluid (CSF) for laboratory analysis.
Psychological evaluation. Busy schedules, anxiety and high expectations are frequently associated with all types of childhood headaches. Some children benefit from working with a psychologist to learn biofeedback and relaxation therapy.
Treatments and drugs

Treatment for headaches in children typically depends on your child's age and the type, severity and frequency of headaches.

Medications
A variety of medications, both over-the-counter (OTC) and prescription, are available for treating headaches in children. Acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) ? along with lifestyle and home measures ? can typically relieve headaches for your child. OTC medications are inexpensive and readily available and don't require a prescription from your doctor.

Children with severe or chronic headaches may require stronger painkillers or preventive medications to reduce the frequency and severity of head pain. The medication strategy differs from child to child, however. Ask your doctor or pharmacist if you have questions.

Many different medications are used for the treatment of headaches in children:
Pain relievers (analgesics). Acetaminophen, ibuprofen and a class of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in reducing headache pain. Prescription NSAIDs include naproxen (Anaprox, others) and ketorolac tromethamine.
Pain reliever combination medications. Acetaminophen and other analgesics are often combined with sedatives and other drugs in a single medication. Combination drugs may be more effective than are pure analgesics for pain relief. One combination medication used for children is Midrin, a combination of isometheptene (constricts blood vessels), dichloralphenazone (a mild sedative) and acetaminophen.
Other medications. Sometimes other medications are used to treat headaches in children. These include triptans, opioids, barbiturates and benzodiazepines, although these medications are typically used with caution because they can be habit-forming. If your child experiences nausea and vomiting with migraines, your doctor may prescribe an anti-nausea drug, such as promethazine (Phenergan).

Medications don't cure headaches, and over time painkillers and other medications may lose their effectiveness. In addition, all medications have side effects. If your child takes medications regularly, including products you buy over-the-counter, discuss the risks and benefits with your doctor.

Therapies
Emotional factors, such as anxiety or stress, can trigger headaches in children. Depression and other mental health disorders also can play a role. For these situations, your doctor may recommend one or more behavior therapies, such as:
Relaxation training. Relaxation techniques include deep breathing, yoga, meditation and progressive muscle relaxation, which is accomplished by tensing one muscle at a time, and then completely releasing the tension, until every muscle in the body is relaxed. An older child can learn relaxation techniques in classes or at home using books or tapes.
Biofeedback training. Biofeedback teaches your child to control certain body responses that help reduce pain. During a biofeedback session, your child is connected to devices that monitor and give feedback on body functions, such as muscle tension, heart rate and blood pressure. Your child then learns how to reduce muscle tension and slow his or her heart rate and breathing. The goal of biofeedback is to help your child enter a relaxed state to better cope with pain.
Cognitive behavioral therapy. This therapy can help your child learn to manage stress and reduce the frequency and severity of headaches. During this type of talk therapy, a counselor helps your child learn ways to view and cope with life events more positively.
Lifestyle and home remedies

Over-the-counter (OTC) pain medications, such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others), are usually effective in reducing headache pain. Before giving your child pain medication, keep these points in mind:
Read labels carefully and use only the dosages recommended for your child.
Don't give doses more frequently than recommended.
Don't give your child OTC pain medication more than two or three days a week. Daily use can trigger a rebound headache, a type of headache caused by overuse of pain medications.
Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children. Talk to your doctor if you have concerns.

In addition to OTC pain medications, the following measures can help ease your child's headache:
Rest and relax. Encourage your child to rest in a dark, quiet room. Sleeping often resolves headaches in children.
Use a cool, wet compress. While your child rests, place a cool, wet cloth on his or her forehead.
Offer a healthy snack. If your child hasn't eaten in a while, offer a piece of fruit, whole-wheat crackers or low-fat cheese. Going without meals can sometimes make headaches worse.
Prevention

The following may help you prevent headaches or reduce the severity of headaches in children:
Practice healthy habits. Behaviors that promote general good health also may help prevent headaches for your child. These lifestyle measures include getting plenty of sleep, staying physically active, eating healthy meals and snacks, and avoiding caffeine.
Reduce stress. Stress may increase the frequency of headaches. Be alert for things that may cause stress in your child's life, such as difficulty doing schoolwork or strained relationships with peers. If your child's headaches are linked to anxiety or depression, consider talking to a counselor.
Keep a headache diary. A diary can help you determine what causes your child's headaches. Note when the headaches start, how long they last and what, if anything, provides relief. Record your child's response to taking any headache medication. Over time, the items you note in the headache diary should help you understand your child's symptoms so that you can take specific preventive measures.
Avoid headache triggers. Avoid any food or drinks, such as those containing caffeine, that seem to trigger headaches. Your headache diary can help you determine what prompts your child's headaches, so you know what to avoid.
Preventive medication. Certain medications taken at regular intervals may reduce the frequency and severity of headaches. Your doctor may recommend preventive medication if the headaches are severe, occur daily and interfere with your child's normal lifestyle.

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