headacheSeizures_drterencio_TRANS.docx

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HEADACHE AND SEIZURES Dr. Bernadette Terencio

February 1, 212

HEADACHE IN !IDS

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Shunt Malfunction

Ty"e#$

Primary Secondary Headache Syndromes E%a&uation 'ana(e)ent Pharmacologic Nonpharmacologic

Acute oca&i0ed Sinusitis titis cular abnormality !ental disease  Trauma  Trauma ccipital Neuralgia  TM/ disorder

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*AIN SENSITI+E STRUCTURES F THE HEAD$  The skin, its blood blood supply and appendages Muscles of the head and neck Great enous sinuses and their tributaries !ura matter at the base of the brain and dural arteries "ntracerebral arteries #erical neres #ranial neres $, $" and $""

Recurrent $ascular !isease "nto)ication M*'S Postsei-ure Hypoglycemia *)ertion

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Cronic *ro(re##i%e  Tumor  Tumor Pseudotumor 0rain abscess Subdural hematoma Hydrocephalus •

*RI'AR- HEADACHES Migraine  Tension%type  Tension%type #luster

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SECNDAR- HEADACHES C #ongenital anomalies anomalies &H#P, 'rnold%#hiari( 'rnold%#hiari( "nfections &meningitis, &meningitis, abscess( abscess( I T  To)in  To)in &cocaine, amphetamine( amphetamine(  Trauma  Trauma &subdural, epidural( epidural( T E *ndocrine &hypoglycemia( Neoplasm &brain tumor, leukemi leukemia( a( N

**FACES PAIN SCALE (Pediatrics)**

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!egeneratie disorder &'le)ander+s &'le)ander+s D disease( $ascular &aneurysm, '$M, coagulation + disorder( ' Metabolic &hypo)ia, dehydration, feer( Secondary Headace &Temporal Presentation( Acute /enera&i0ed Systemic infection #NS infection  To)ins&lead,  To)ins&lead,#( #( Postsei-ure *lectrolyte imbalance Hypertension Hypoglycemia PostP  Trauma  Trauma *mbolism $ascular thrombosis Hemorrhage #ollagen disease *)ertion

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**Migrai **Migraine ne happens happens in children children as early early as 5 years years old; usually relieved by rest, sleep and medications** ** At nighttime, Rhythym becomes shallow, dec O2, inc CO2 **nc CO2! potent vasodilator  **"ec O2! potent vasoconstrictor 

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IHS 'I/RAINE CASSIFICATIN 1.1 Migraine 2ithout aura &common migraine(

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mcps 

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1.3 Migraine 2ith aura &classic migraine( 1.3.1 Migraine 2ith typical aura 1.3.3 Migraine 2ith prolonged aura 1.3. 5amilial hemiplegic migraine 1.3.4 0asilar migraine 1.3.6 Migraine aura 2ithout headache • • • • •

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1.3.7 Migraine 2ith acute onset aura

1. phthalmoplegic migraine

C&inica& A""roac to te Ci&d *re#entin( it Headace ?ey information re@uired from Medical History  Temporal pattern of headache !uration, fre@uency, location, @uality and seerity of pain *)acerbating; alleiating factors 8esponse to treatment 'ura Past h) of headache #hanging @uality;location;seerity of pain 5amily history of headache  To)ic e)posure, intake of drugs  Trauma 'ssociated symptoms;Neurologic symptoms Sinus or dental pain,nasal discharge,facial pain Past medical history

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1.4 8etinal migraine 1.6 #hildhood periodic syndromes that may be precursors to or associated 2ith migraine 1.6.1 0enign paro)ysmal ertigo 1.6.3 'lt. hemiplegia •

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'I/RAINE ASSCIATED S-'*T'S #$ewis and %inner, 2&&'(

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*rodro)a& &hours or day in adance( Mood changes "rritability *uphoria "ncreased thirst "ncreased urination 5luid retention 5ood craing &high carbohydrate food(  9a2ning, sighing • • • •

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Re3uired E&e)ent# o4 a Torou( *y#ica& and Neuro&o(ic E5a)ination $ital signs 0lood pressure, pulse, respiration •

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Te eadace Gradual onset *scalation oer minutes to hours asts 3%:3 hours 5rontal, bitemporal, retro%orbital, unilateral Pounding, pulsing, throbbing "ntensity increased by actiity •

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Autono)ic #y)"to)# Nausea, omiting, anore)ia Peroumbilical abdominal pain !iarrhea Pallor Phonophobia;Photophobia !esire to sleep #ool e)tremities Periorbital discoloration "ncreased or decreased blood pressure Syncope •

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High priority #hronic progressie pattern 'cute headache •

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5unduscopic e)amination #ardiopulmonary e)amination Skin rashes, petechiae, ecchymosis, needle tracts Hepatosplenomegaly Neurologic e)am I)a(in( 4or te E%a&uation o4 Headace

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General physical e)amination Nuchal rigidity, TM/, dental, lymph node tenderness,etc

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Aorst headache of life

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'i#ce&&aneou# Motion sickness Sleep 2alking 8ecurrent abdominal pain • • •

Tunderc&a" eadace 'bnormal neurologic e)amination 5ocal neurologic symptoms Presence of $P shunt Presence of neurocutaneous syndrome 'ge B  years • • • • •

'i(raine Aura# Binocu&ar %i#ua& i)"air)ent it #coto)a

'oderate "riority Headache or omiting on a2akening Cnarying location of headache Meningeal signs • •

Di#tortion or a&&ucination# Micropsia Macropsia Matamorphopsia  Teleopsia

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'onocu&ar %i#ua& i)"air)ent or # coto)a central scotomas Spotty scotomas Hemianopia • • •

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S"ectru) o4 Dia(no#e# 4or Headace at 'ia)i Ci&dren6# Ho#"ita& E)er(ency De"art)ent $iral illness D.3E Sinusitis 17E Migraine 16.7E Post%traumatic !isorder 7.7E $iral Meningitis 6.3E Streptococcal Pharyngitis 4.DE  Tension 4.6E

Napro)en

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)rattCheney +$ etal, )ediatric -mergency Care, '../

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'o#t Fre3uent Dia(no#e# 4or Headace at a Sort7 Stay Unit

"nfection  Tension Migraine Non%speciFc

1E 3DE 31E 14E

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1mg;kg

Co)bination Ana&(e#ic 5ioricet 0utalbitalI'cetaminophenI#aJeine *sgicplus ')ocet

Acute Treat)ent Strate(ie#$ 'oderate to Se%ere 'i(raine 6%HT1 agonists &triptan( *rgotamine &dihydroergotamine( Nonsteroidal anti%in=ammatory drugs 'ntiemetics pioid analgesic • • • • •

0asheh 1 etal, )ediatrics, '...

*re%enti%e 'i(raine Tera"y

Acute Headace in *ediatric E)er(ency De"art)ent

Cpper 8espiratory Tract "nfection $iral "nfection Sinusitis Strep pharyngitis Migraine $iral Meningitis 0rain Tumors Shunt Malfunction "ntracranial Hemorrhage Post%ictal Headache Post%concussie Headache Cndetermined cause

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6:E &DE( &DE( &DE( 1E DE 3.7E

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3E 1.E 1.E 1.E 1.E $ewis "% etal, eadache, 2&&&

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A(ent #yproheptadine HS Propranolol 0"!  Tricyclics 'mitriptyline 1mg HS Nortriptyline 1mg HS !ialproe) sodium 136mg K!

Initia& Do#a(e 3 mg 0"! or 4 mg

1mg;kg up to 1mg

.36mg%.6mg;kg to .36mg%.6mg;kg to 1mg;kg to

Non"ar)aco&o(ic Treat)ent o4 'i(raine *ducation 0iofeedback Stress management and rela)ation e)ercises *limination of triggers Sleep regulation *)ercise

Dru( Tera"y 4or Headace#$ Aborti%e Tera"y Dru( • • • • • • •

'i(raine Tri((er# FDS 8ipened cheeses #hocolate $inegar &e)cept 2hite inegar( Sour cream, yogurt Nuts, peanut butter Hot fresh breads, doughnuts ima beans, pea pods MSG 0ananas Pi--a Permented sausages, balogna, pepperoni, hotdogs #aJeine 5ood dyes

*rgotamine !ihydroergotamine "sometheptene  Triptans #hlorproma-ine,prometha-ine Metoclopromide idocaine &4E(

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'ecani#)# $asoconstrictor $asoconstrictor $asoconstrictor Serotonin agonists 'ntiemetic, sedatie, adrenergic 'ntiemetic ocal anesthetic

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Acute Treat)ent Strate(ie#$ 'i&d to 'oderate Headace#

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Si)"&e ana&(e#ic# Do#a(e 'cetaminophen 16mg;kg "buprofen

DRS Perfume Gasoline $arious food odors • • •

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STRESSES School 2ork *)cess number of e)tracurricular actiities 8elationships •

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!isruption of lifestyle 5eeling or sad all the time

SUCCESSFU 'ANA/E'ENT F *EDIATRIC HEADACHE 8eassure patient and parents there is no central nerous system lesion. *ducate patients and their parents about the pathogenesis and natural history of migraine. *stablish realistic goals for treatment according to age. •

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*SSIBE CAUSES F SEIZURES IN ADUTS Head trauma  -oun( adu&t# 'lcoholism 0rain tumor &der adu&t#

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SEIZURES

Sei-ure •

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'n occasional e)cessie and disordered discharge of nere tissue Manifestation of transient hypersynchronous abnormal neuronal behaior

0rain tumor #$' Metabolic disorders 'lcoholism

:y C&a##i4y;

5acilitate communication among professionals 5acilitate communication bet2een physician and patient 'id diagnosis 8ational prescribing of '*!s based on accurate diagnosis of sei-ure type Prognosis

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De8nition Sei0ure L transient manifestation of abnormal hypersynchronous discharges of cortical neurons

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E"i&e"#y L disorder characteri-ed by the occurrence of at least 3 unprooked   sei-ures

E"i&e"tic #yndro)e L a disorder consisting of a cluster of signs and symptoms plus its typical **G Internationa& ea(ue A(ain#t E"i&e"#y I'IDE % Frst choice for 'bsence sei-ure 2ithout generali-ed tonic%clonic sei-ures

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