December Week 1
ARTICLES:
Migraine Headaches in Children.
Harvey S Singer. Pediatrics in Review Vol. 15 No. 3 March 1, 1994 pp. 94 -101 (Article emailed separately)
CASE ONE:
Pt Y is a 10 year old male who presents to the ER with complaint of “throbbing pain” on the left side of his forehead for the past 2-3 hours. Mom states he has had “migraines” in the past, but never as bad as this one. He describes pain with the light on in the exam room, rates the pain 10/10 and has vomited 2x since eating dinner about 2 hours ago. He states he “just wants the pain” to go away. Mom pleads for help immediately, stating she herself also gets these types of headaches. His neurologic exam is normal and his VS are stable.
1) How would you classify this headache?
2) Do you think this child requires imaging?
3) How would you manage this child?
CASE TWO:
Pt X is a 17 y/o female who presents to her pediatrician with a complaint of 20 missed school days in the past 3 months due to “headache”. She states the headaches happen about 2-3 times per week, typically after nights spent up late doing homework (Pt X is a junior in HS wishing to apply early to Georgetown). She feels the headache ” pulsating across her forehead. She typically feel nasueus beforehead, but doesn’t vomit. She rates the pain as 8-9/10. She denies any visual changes. The headaches are occasionally responsive to 800 mg Ibuprofen, but typically she sleeps on a missed school day for 8-10 hours and wakes up with a resolved headache. In the office she is afebrile with normal vital signs. Her physical exam in normal. She denies a headache today. Both she and her mother would like some recommendations for “treatmen options”.
1) How would you classify Pt X’s headache?
2) What would your first step in managing her headache be?
3) Do you think this patient is at greater need for medical therapy (please suggest what you might prescibe) versus a more holisitic therapy (also please suggest where you might refer).