Headache In Children

Migraine commonly produces episodic headache with nausea, vomiting, photophobia or phonophobia. Children may have bilateral rather than unilateral pain and attacks may be shorter than in adults.

Red flags include:

• Progressive worsening
• Early morning vomiting
• Headache waking the child
• Focal neurological deficit
• Papilloedema
• New seizures
• Personality or school performance change
• Occipital headache with neurological signs
• Headache in a child with cancer or immunosuppression

For acute migraine:

• Ibuprofen 10 mg/kg PO, maximum 400 mg per dose

• Paracetamol 15 mg/kg PO, maximum 1 g per dose.

Give treatment early in the attack.

Ondansetron may be used for significant nausea or vomiting.

Frequent disabling migraines require trigger management and consideration of prophylactic therapy under paediatric or neurological supervision.

Avoid medication overuse, which can itself perpetuate chronic headache.

Epilepsy In Children

Epilepsy is a neurological disorder characterized by an enduring predisposition to recurrent unprovoked seizures. Classification as focal, generalized, combined generalized and focal, or unknown onset directs investigation and antiseizure therapy.

One provoked seizure from fever, hypoglycaemia, meningitis or another transient insult does not establish epilepsy.

Seizures may present as:

• Generalized tonic clonic episodes
• Focal motor seizures
• Focal impaired awareness episodes
• Absence seizures
• Myoclonic seizures
• Atonic seizures

History from a witness or video recording is often more diagnostically valuable than examination between attacks.

Look for developmental regression, focal neurological deficits, neurocutaneous abnormalities and family history.

Choose treatment according to seizure type.

• Focal seizures: levetiracetam or lamotrigine are commonly preferred first line options.

• Generalized tonic clonic seizures: levetiracetam, lamotrigine or sodium valproate may be appropriate depending on sex, age and epilepsy syndrome.

• Absence epilepsy: ethosuximide is preferred for isolated absence seizures; valproate is useful where generalized tonic clonic seizures coexist.

A practical levetiracetam starting dose is 10 mg/kg PO twice daily, titrated according to response, commonly to 20 to 30 mg/kg twice daily.

Sodium valproate is highly effective for generalized epilepsies but requires major caution in girls and adolescents because of teratogenic and neurodevelopmental fetal risk.

Do not stop antiseizure medication abruptly.

Drug resistant epilepsy requires specialist evaluation for syndrome classification, dietary therapy, epilepsy surgery or advanced treatment.

Headache In Children

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management