Pediatric Headaches in Clinical Practice Pediatric Headaches in Clinical Practice Andrew D. Hershey, Scott W. Powers, Paul Winner and Marielle A. Kabbouche © 2009 John Wiley & Sons, Ltd. ISBN: 978-0-470-51273-9 Pediatric Headaches in Clinical Practice Andrew D. Hershey, MD, PhD, FAHS Cincinnati Children’s Hospital Medical Center, Professor of Pediatrics and Neurology University of Cincinnati, College of Medicine, Cincinnati, OH, USA Scott W. Powers, PhD, ABPP, FAHS Cincinnati Children’s Hospital Medical Center, Professor of Pediatrics Division of Behavioral Medicine and Clinical Psychology University of Cincinnati, College of Medicine Cincinnati, OH, USA Paul Winner, DO, FAAN, FAAP, FAHS Palm Beach Neurology, West Palm Beach, FL, Clinical Professor of Neurology Nova Southeastern University, Fort Lauderdale, FL USA Marielle A. Kabbouche, MD Cincinnati Children’s Hospital Medical Center, Assistant Professor of Pediatrics and Neurology, University of Cincinnati, College of Medicine, Cincinnati, OH, USA This edition first published 2009, # 2009 John Wiley & Sons, Ltd Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. Registered office: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Other Editorial Offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. 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No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloguing-in-Publication Data Pediatric headaches in clinical practice / Andrew D. Hershey ... [et al.]. p. ; cm. Includes bibliographical references and index. ISBN 978-0-470-51273-9 (cloth) 1. Headache in children. I. Hershey, Andrew D. [DNLM: 1. Headache Disorders. 2. Adolescent. 3. Child. 4. Headache. 5. Pediatrics–methods. WL 344 P371 2009] RJ496.H3P33 2009 618.92’8491–dc22 2008053890 ISBN: 9780470512739 A catalogue record for this book is available from the British Library. Typeset in 10.5/13pt Times by Thomson Digital, Noida, India. Printed in Singapore by Markono Print Media Pte. Ltd. First Impression 2009 Contents Preface ix 1 History of Childhood Headaches 1 Andrew D. Hershey 1.1 Childhood Headaches 2 1.2 Migraine Variants and the Periodic Syndromes 6 1.3 Classification and Criteria for Headaches 7 2 Evaluation and Classification 13 Andrew D. Hershey 2.1 Evaluation 13 2.2 Classification 17 3 Diagnostic Testing and Concerning Variants 21 Marielle A. Kabbouche 3.1 Neuroimaging 24 3.2 EEG 26 3.3 Lumbar Puncture 27 3.4 Clinical Laboratory Testing 28 4 Epidemiology of Pediatric Headache 31 Paul Winner 4.1 Epidemiology of Migraine 32 4.2 Incidence 32 4.3 Prevalence 32 4.4 The AMPP Study 34 4.5 Disability 35 4.6 Treatment Issues 36 4.7 Other Primary Headaches 36 4.8 Conclusions 36 vi CONTENTS 5 Impact of Childhood Headaches 41 Scott W. Powers 5.1 Childhood Headache and Quality of Life 41 5.2 Evidence-based Assessment in Clinical Practice 42 5.3 Summary 42 6 Emergent Evaluation and Management 45 Marielle A. Kabbouche 6.1 Emergency-Room Evaluation and Management 45 6.2 Treatments of Primary Headache in a Pediatric Emergency Room 53 6.3 Management of Primary Headache in an Inpatient Unit 57 6.4 Conclusions 59 7 Pathophysiology of Primary Headaches 61 Andrew D. Hershey 7.1 Migraine 61 7.1.1 Genetic Factors 62 7.1.2 Population Studies 62 7.1.3 Specific Genes 65 7.1.4 Neuropeptides and Transmitters 70 7.1.5 Factors Influencing Headache Characteristics 71 7.1.6 Neuroimaging 73 7.2 TTHs: Tension-type Headaches 74 8 Migraine: Diagnosis and Treatment 83 Paul Winner 8.1 Diagnosis 83 8.2 Treatment 88 8.3 Conclusions 95 9 Childhood Periodic Syndromes 101 Marielle A. Kabbouche 9.1 BPV: Benign Paroxysmal Vertigo 102 9.2 AM: Abdominal Migraine 104 9.3 CVS: Cyclical Vomiting Syndrome 107 9.4 AHC: Alternating Hemiplegia of Childhood 112 9.5 BPT: Benign Paroxysmal Torticolis 114 CONTENTS vii 10 Tension-type Headache: Diagnosis and Treatment 117 Andrew D. Hershey 10.1 Diagnosis of Tension-type Headaches (TTHs) 117 10.2 Epidemiology 120 10.3 Treatment 120 11 Chronic Daily Headaches in Children 125 Paul Winner 11.1 Classification 126 11.2 Epidemiology 127 11.3 Clinical Characteristics 128 11.4 Diagnosis 130 11.5 Management 131 11.6 Preventative Therapy 132 11.7 Analgesic Agents 136 11.8 Nonpharmacologic 137 11.9 Prognosis 138 11.10 Conclusions 138 12 Other Primary Headache Disorders 143 Marielle A. Kabbouche 12.1 Introduction 143 12.2 Cluster Headache 144 12.3 Paroxysmal Hemicrania 148 12.4 SUNCT: Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing 150 12.5 Probable TAC 152 12.6 Differential Diagnosis of ‘TAC’ and Short-Lasting Headaches 153 12.7 Other Primary Headaches 154 13 Biobehavioral Management of Childhood Headaches 163 Scott W. Powers 13.1 Lifestyle Habits 163 13.2 Pharmacologic Adherence 164 13.3 Nonpharmacological Interventions 165 13.4 Summary 168 14 Sinus Headache and Nasal Disease 169 Andrew D. Hershey 14.1 Identification of Sinus Headache 169 viii CONTENTS 14.2 Epidemiology 171 14.3 Sinus Headache Diagnosis 173 14.4 Treatment 174 14.5 Summary 174 14.6 Other Nasal Diseases and Headache 175 15 Posttraumatic Headaches 177 Paul Winner 15.1 Diagnostic Issues 179 15.2 Considerations for Returning to Play After a Concussion Injury 181 15.3 Evaluations 182 15.4 Neuropsychologic Testing 182 15.5 Management 183 15.6 Conclusions 185 16 Headaches Associated with Altered Intracranial Pressure 189 Andrew D. Hershey 16.1 Increased Intracranial Pressure 189 16.2 Decreased Intracranial Pressure 196 17 Other Secondary Headaches 201 Andrew D. Hershey 17.1 Epidemiology 202 17.2 Evaluation 204 17.3 Selected Secondary Headaches 206 17.4 Conclusions 210 Index 213 Preface Head pain is a nearly universal experience for humans, yet it remains poorly recognized as a significant problem. The experience has been observed across all ages, yet the presentation and underlying etiology vary across the developmental scale. In the developing nervous system, these changes occur rapidly as a child’s awareness and ability to express this symptom as a problem mature and the very nature of the symptoms evolves. Although many of the well observed patterns of adult head pain are applicable to children, the unique aspects of evaluating and treating children in association with the variations that occur in childhood headache disorders continue to make the management of these diseases a challenge. A perspective that goes beyond the downward application of information derived from the adult headache experience is needed. This book will help you answer challenges specific to pediatric headache. This universal nature of head pain creates a familiarity that is both a barrier and a challenge.