Pediatric Headache in the Emergency Department.
Incidence has increased in the last years probably due to children´s lifestyle changes. Headaches have a wide variety of causes, either primary or secondary ones. While the majority of headaches are self-limited and benign, headaches occasionally herald a life-threatening illness such as a brain tumor, intracranial hemorrhage or meningitis. The emergency department physician has to distinguish between “benign” and “serious” headaches and therefore must have an organized approach to the evaluation of these patients. An extensive history and physical examination are crucial and must guide the differential diagnosis.
Pain originating from the cranial circulation as well as the intracranial structures above the tentorium travels primarily via the trigeminal nerve and is referred to the front of the head. However, complex nerve relationships and unpredictable displacement of structures by mass lesions can cause unexpected paths of pain referral. Tension-type headaches are common in children. They tend to be mild compared to migraines, and patients may not seek medical attention.
Medical treatment should focus on abortive analgesics to alleviate the pain. Opioids and benzodiazepines have no role in the management of primary headaches. Clinicians often consider ibuprofen to be more effective than acetaminophen in the management of pain.
Several authors have concluded that oral triptans are not as effective in children as in adults. However, nasal sumatriptan is promising. Most studies evaluating oral sumatriptan, oral rizatriptan and oral zolmitriptan found no effectiveness of these medications for pain relief in children.
Pediatr Neonatal Nurs Open J. 2016; 2(3): 99-103. doi: 10.17140/PNNOJ-2-116