Management Of Headache In The Pediatric Emergency Department
0
TOC Will Appear Here

Management Of Headache In The Pediatric Emergency Department

2,484 views
Below is a free preview. Log in or subscribe for full access. Or, get a free sample article ED Assessment and Management of Pediatric Acute Mild Traumatic Brain Injury and Concussion:
Please provide a valid email address.
Table of Contents
 
Table of Contents
  1. Abstract
  2. Case Presentation
  3. Introduction
    1. Prevalence Of Headache
  4. Critical Appraisal Of The Literature
  5. Classification Of Headache Disorders
    1. Primary Headache
      1. Migraine Headache
      2. Migraine Without Aura
      3. Migraine With Aura
      4. Rare Forms Of Migraine
      5. Tension-Type Headache
      6. Cluster Headache
  6. Pathophysiology
    1. Primary Headache
      1. Migraine
      2. Cortical Spreading Depression
      3. Genetic Predisposition
      4. Tension-Type Headache
      5. Cluster Headache
    2. Secondary Headache
      1. Posttraumatic Headache
      2. Other Causes
  7. Differential Diagnosis
  8. Emergency Department Evaluation
    1. History
    2. Disease-Specific History Findings
      1. Migraine Headache
      2. Tension-Type Headache
      3. Cluster Headache
      4. Sinus Headache
      5. Head Trauma/Posttraumatic Headache
      6. Intracranial Masses
      7. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
      8. Malignant Hypertension
      9. Meningitis
      10. Epilepsy
      11. Medication Overuse Headache
    3. Physical Examination
  9. Diagnostic Studies
    1. Brain Imaging
      1. Imaging Recommendations For Primary Headaches:
      2. Imaging Recommendations For Secondary Headaches:
    2. Laboratory Studies
      1. Lumbar Puncture
  10. Treatment
    1. General Principles
    2. Disease-Specific Pharmacological Interventions
      1. Abortive Pharmacological Interventions For Migraine
        • Nonsteroidal Anti-Inflammatory Drugs And Acetaminophen
        • Dopamine Receptor Antagonists
        • Triptans
        • Dihydroergotamine
      2. Prophylactic Pharmacological Interventions For Migraine
      3. Tension-Type Headache Treatment
      4. Cluster Headache Treatment
      5. Secondary Headache Treatment
        • Sinusitis Treatment
        • Medication Overuse Headache Treatment
        • Intracranial Space-Occupying Lesion Treatment
        • Idiopathic Intracranial Hypertension Treatment
        • Malignant Hypertension Treatment
        • Meningeal Inflammation Treatment
        • Postlumbar Puncture Headache Treatment
  11. Controversies And Cutting Edge
    1. Intranasal Ketamine
    2. Low-Dose Propofol
  12. Disposition
    1. Indications For Referral
    2. Criteria For Admission
    3. Complications
    4. Prognosis
    5. Patient Education
  13. Summary
  14. Clinical Pathway For Diagnosis Of Pediatric Headache In The Emergency Department
  15. Clinical Pathway For Treatment Of Pediatric Primary Headache
  16. Risk Management Pitfalls For Pediatric Headache Managment
  17. Time- And Cost-Effective Strategies
  18. Case Conclusions
  19. Tables
    1. Table 1. International Headache Society Diagnostic Criteria: Migraine Without Aura
    2. Table 2. International Headache Society Diagnostic Criteria: Migraine With Aura
    3. Table 3. International Headache Society Diagnostic Criteria: Tension-Type Headache
    4. Table 4. International Headache Society Diagnostic Criteria: Cluster Headache
    5. Table 5. Typical Primary Headache Characteristics
    6. Table 6. Differential Diagnosis For Pediatric Headache
    7. Table 7. Factors Known To Precipitate Migraine Headaches
  20. References

Abstract

Headaches are a common complaint among children, with increasing frequency in adolescence. According to the Agency for Healthcare Research and Quality, more than 3 million Americans seek emergency care every year due to headaches, and one-third of them are attributable to migraines. Headaches have a significant impact on the lives of children and adolescents, resulting in school absence, decreased extracurricular activities, and poor academic achievement. Among patients, the spectrum of pathology varies widely, continually challenging healthcare providers to recognize serious, life-threatening conditions, while judiciously evaluating and treating all patients. This issue reviews the broad differential of primary and secondary headaches in the pediatric emergency department, summarizes effective strategies for diagnosis, and evaluates the current evidence supporting safe, appropriate treatment. As emergency clinicians treat increasingly more medically complex patients, they should be aware of the best current practices to evaluate and treat headaches in the pediatric population.

Key words: pediatric headache, primary headache, secondary headache, migraine, aura, tension-type headache, cluster headache, triptan, NSAID

Case Presentation

A 14-year-old girl with no significant past medical history presents to your ED with a chief complaint of headache. She describes the pain as 9/10, bifrontal, and associated with nausea and photophobia. She denies fevers, recent illness, or any trauma. When you review her family history, you note that her mother suffers from frequent headaches. Her vital signs and physical exam are all within normal limits.

An 11-year-old boy presents to your ED with a persistent headache. His past medical history is notable for a helmet-to-helmet collision during a football game 1 month prior to presentation. Since that time, he has also complained of difficulty concentrating, dizziness, and fatigue. On your exam, you note a poorly cooperative boy with normal vital signs who is in no acute distress. He repeatedly asks you to lower your voice and refuses to cooperate with your ophthalmic exam. The remainder of your physical exam is unrevealing.

An 18-year-old male presents to your ED with severe headache and fever for the past 3 days. Your examination reveals an ill-appearing male with photophobia and neck stiffness.

How would you approach the evaluation and treatment of these headaches?

Introduction

The presence of a severe headache is anxiety-provoking in both parents and children. When treating patients with headaches in the emergency department (ED), the primary objective of the emergency clinician is to promptly recognize the life-threatening conditions requiring immediate medical or operative management. In addition, appropriate assessment and treatment of less-severe headaches have the potential to prevent unnecessary hospital admissions. A recent study evaluating patients who presented to the ED with a chief complaint of headache demonstrated that the most common cause of headache was upper respiratory infection (19.2%). Migraines, posttraumatic headaches, and tension-type headaches accounted for 18.5%, 5.5%, and 4.6%, respectively. Serious, life-threatening headaches (4.1%) including meningitis (1.6%), acute hydrocephalus (0.9%), and tumors (0.7%) were lesscommon etiologies.1 For optimal assessment and management of headaches, emergency clinicians must be familiar with the broad clinical spectrum of etiologies for headache in the pediatric population.

Prevalence Of Headache

Ninety-six percent of American adults report having had a headache in their lifetime, and nearly 40% have had a significant headache at some point.2 Among children, the prevalence of major headache ranges from 37% to 51% during the elementary school years and gradually rises to 57% to 82% by adolescence. Frequent or severe headaches (including migraines) were reported by 17% of participants in a national sample of children and adolescents.3 Headache ranks as the third leading cause of referral to a pediatric ED.4 The most common type of recurrent headache in childhood is migraine; in adolescence, tension headaches are the most common type of frequent headache.5

Estimates of the overall prevalence of headache in children vary among researchers. Secondary headaches are most frequently encountered before the age of 5 years; however, a primary headache (such as migraine) can occur as early as a few months of age. Chronic tension-type headache has been reported in 0.9% of 15-year-old children.6

In a widely cited study, Bille surveyed 8993 children aged 7 to 15 years and found that 59% had suffered headache at some time in their life.7 In a systematic questionnaire of 2941 children, Sillanpaa found the prevalence of headache to be 37% at age 7 years, increasing to 69% by 14 years; migraine accounted for 2.7% and 10.6% of these headaches, respectively.8

Studies have shown that up to 51% of children aged 7 years and 57% to 82% of adolescents aged 15 years report recurrent headaches.9,10 A study performed in Taiwan indicated that approximately 85% of children aged 13 to 15 years have had headache.11 According to a large survey by Split and Neuman, 75% of children have suffered headaches by age 15 years.12

Critical Appraisal Of The Literature

A literature search was performed using the following databases: PubMed, Web of Science, Ovid MEDLINE ®, Cochrane Database of Systematic Reviews, and Scopus. Searches were limited to those published in English. Search terms included pediatric headache, child, children, emergency, primary headache, and secondary headache. Defining the specific type of headache further refined the search, using the terms migraine, aura, migraine equivalent, tension-type, cluster, posttraumatic, concussion, pseudotumor cerebri, intracranial hypertension, sinusitis, intracranial mass, medication overuse, seizure, infection, and meningitis. The search returned 12,155 abstracts that were reviewed for relevance. The bibliographies of the relevant articles were also reviewed for additional publications. In addition, guidelines from the Agency for Healthcare Research and Quality (AHRQ) through the National Guidelines Clearinghouse (www.guidelines.gov) were reviewed. Review of the literature revealed a tremendous body of data available from adult studies, from which pediatric treatments have been extrapolated. The pediatric literature is growing, and the available data from pediatric studies are reviewed in this article.

Risk Management Pitfalls For Pediatric Headache Managment

The greatest medical pitfall in pediatric headache management is failure to make an accurate diagnosis. Effective treatment of headache relies on identification of the underlying cause. In the setting of an abnormal physical examination or certain historical red flags, a headache must be considered a secondary headache until otherwise ruled out.

  1. “I thought the teenager with unilateral facial numbness was having an atypical migraine, so I sent her home with a triptan and told her to follow up with her pediatrician.” Careful history-taking and thorough neurological examination can help make the correct diagnosis. A high index of suspicion is needed to avoid missing a secondary headache. Remember that primary headaches are diagnoses of exclusion.
  2. “The patient was really sick and I didn’t want to sterilize the cultures, so I made sure to perform the lumbar puncture before giving antibiotics.” When faced with a decompensating patient with possible meningitis, do not delay the administration of life-saving antibiotics. Lumbar puncture is meant to aid in diagnosis; if you already know the treatment is needed urgently, do not wait.
  3. “The patient has a history of multiple concussions, so I figured his progressively worsening headache was just part of a posttraumatic headache.” Concussions and previous head injuries can be challenging to manage, but it is important to recognize acute on chronic changes or progression of symptoms as possible clues to more ominous pathology such as intracranial hemorrhage or venous thrombosis.
  4. “The patient was only 13, so I didn’t bother to check a urine pregnancy test.” Among female adolescents who are of childbearing age, eclampsia must be considered until pregnancy has been ruled out. In addition, some migraine medications, such as triptans and DHE, are contraindicated or discouraged in pregnancy. Urine pregnancy tests are inexpensive, readily available in the ED, and generally more reliable than the average teenager.
  5. “The patient has had the same headache for 2 months, so I got a head CT to find out why.” Chronic headaches without progression of symptoms or other red flags do not always require emergent head imaging. In fact, an MRI (which can be arranged as an outpatient) may provide a more thorough evaluation and avoid unnecessary exposure to ionizing radiation.
  6. “He said he gets sinus headaches all the time, so I gave him a prescription for amoxicillin and sent him on his way.” Sinusitis can cause headache; however, these patients are more likely to suffer from under-recognized primary headaches such as migraines and tension-type headaches. Judicious use of antibiotics is necessary to prevent resistance, and diagnosis-specific medications are important to address the pain.
  7. “The patient was in so much pain, I had to give him additional doses of morphine.” Narcotics play little role in the management of headaches and no role in the management of primary headaches. They may provide a quick fix, but this effect is fleeting and is typically followed by rebound headaches that have been recognized as medication overuse headaches.
  8. “He kept saying his headaches bothered him the most in the mornings – I thought he just didn’t want to go to school.” Early-morning headache is a red flag for an intracranial space-occupying lesion. A thorough history and physical examination should help differentiate this worrisome secondary headache from behavioral misconduct. Beware of drawing such conclusions before life-threatening pathology has been effectively ruled out.
  9. “She had papilledema on examination after a fall from a 3-story window, so I ordered an MRI right away.” A good fundoscopic examination should be performed on every patient. Since papilledema may suggest increased intracranial pressure, it is important to remember that timeliness is key. Even if MRI is available, if you have concern for an acute bleed with potential for rapid decompensation, CT would be your imaging modality of choice.
  10. “This was her third visit to the ED with status migrainosus in the last 2 months, so I started her on cyproheptadine to prevent a fourth visit.” Evidence for use of migraine prophylaxis in children is poor. If indicated, migraine prophylaxis should be administered by the patient’s medical home (primary care provider or neurologist) with a plan in place for good follow-up care. Lack of follow-up when starting chronic medications may lead to medication overuse or hazardous, unchecked medication side effects.

Tables

Table 1. International Headache Society Diagnostic Criteria: Migraine Without Aura

Table 2. International Headache Society Diagnostic Criteria: Migraine With Aura

Table 3. International Headache Society Diagnostic Criteria: Tension-Type Headache

Table 4. International Headache Society Diagnostic Criteria: Cluster Headache

References

Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study will be included in bold type following the references, where available. The most informative references cited in this paper, as determined by the author, will be noted by an asterisk (*) next to the number of the reference.

  1. Conicella E, Raucci U, Vanacore N, et al. The child with headache in a pediatric emergency department. Headache. 2008;48(7):1005-1011.
  2. Rasmussen BK, Jensen R, Schroll M, et al. Epidemiology of headache in a general population--a prevalence study. J Clin Epidemiol. 1991;44(11):1147-1157. (Prevalence study; 740 patients)
  3. Lateef TM, Merikangas KR, Jianping He, et al. Headache in a national sample of American children: prevalence and comorbidity. J Child Neurol. 2009;24(5):536-543. (Prevalence study; 10,918 patients)
  4. Kabbouche MA, Cleves C. Evaluation and management of children and adolescents presenting with an acute setting. Semin Pediatr Neurol. 2010;17(2):105-108. (Review)Raieli V, Eliseo M, Pandolfi E, et al.
  5. Recurrent and chronic headaches in children below 6 years of age. J Headache Pain. 2005;6(3):135-142. (Retrospective chart review; 1598 patients)
  6. Abu-Arefeh I, Russell G. Prevalence of headache and migraine in schoolchildren. BMJ. 1994;309(6957):765-769. (Prevalence study; 2165 patients)
  7. Bille BS. Migraine in school children. A study of the incidence and short-term prognosis, and a clinical, psychological and electroencephalographic comparison between children with migraine and matched controls. Acta Paediatr Suppl. 1962;136:1-151. (Epidemiologic study)
  8. Sillanpaa M. Changes in the prevalence of migraine and other headaches during the first seven school years. Headache. 1983;23(1):15-19. (Prevalence study; 3784 patients)
  9. Fendrich K, Vennemann M, Pfaffenrath V, et al. Headache prevalence among adolescents--the German DMKG headache study. Cephalalgia. 2007;27(4):347-354. (Populationbased cross-sectional study; 3324 patients)
  10. Lewis DW, Ashwal S, Dahl G, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;59(4):490- 498. (Review)
  11. Lu SR, Fuh JL, Juang KD, et al. Migraine prevalence in adolescents aged 13-15: a student population-based study in Taiwan. Cephalalgia. 2000;20(5):479-485. (Prevalence study; 4064 patients)
  12. Split W, Neuman W. Epidemiology of migraine among students from randomly selected secondary schools in Lodz. Headache. 1999;39(7):494-501. (Epidemiologic study; 2352 patients)
  13. The International Classification Committee of the International Headache Society. The international classification of headache disorders: 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808. (Professional society classification)
  14. Sillanpaa M. Prevalence of headache in prepuberty. Headache. 1983;23(1):10-14. (Prevalence study; 3784 patients)
  15. Pakalnis A, Gladstein J. Headaches and hormones. Semin Pediatr Neurol. 2010;17(2):100-104.
  16. Lewis DW. Headaches in children and adolescents. Am Fam Physician. 2002;65(4):625-632. (Review)
  17. Podestà B, Briatore E, Boghi A, et al. Transient nonverbal learning disorder in a child suffering from familial hemiplegic migraine. Cephalalgia. 2011;31(14):1497-1502. (Case report; 1 patient)
  18. Gelfand AA, Gelfand JM, Prabakhar P, et al. Ophthalmoplegic “migraine” or recurrent ophthalmoplegic cranial neuropathy: new cases and a systematic review. J Child Neurol. 2012;27(6):759-766. (Systematic review; 84 patients)
  19. Cady R, Schreiber C, Farmer K, et al. Primary headaches: a convergence hypothesis. Headache. 2002;42(3):204-216. (Editorial)
  20. Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurol. 2008;7(1):70- 83. (Review)
  21. Burstein R, Cutrer MF, Yarnitsky D. The development of cutaneous allodynia during a migraine attack. Clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine. Brain. 2000;123(8):1703- 1709. (Case report; 1 patient)
  22. Hoffmann J. Recent advances in headache research. Expert Rev Neurother. 2011;11(10):1379-1381. (Expert review)
  23. Goadsby PJ. Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol. 2002;1(4):251-257. (Review)
  24. Pascual-Lozano AM, Salvador-Aliaga A, Láinez-Andrés JM. Posttraumatic headache. Pathophysiology, clinical, diagnostic and therapeutic aspects [in Spanish]. Neurologia. 2005;20(3):133-142. (Review)
  25. Phillips PH. Pediatric pseudotumor cerebri. Int Ophthalmol Clin. 2012;52(3):51-59, xii. (Review)
  26. Lopez JI, Bechtel KA, Rothrock JF, et al. Pediatric headache differential diagnoses. [Medscape Reference Web site]. Available at: http://emedicine.medscape.com/ article/2110861-differential. Accessed March 15, 2013. (Review)
  27. Lynch KM, Brett F. Headaches that kill: a retrospective study of incidence, etiology and clinical features in cases of sudden death. Cephalalgia. 2012;32(13):972-978. (Retrospective study; 55 patients)
  28. Lamont AC, Alias NA, Win MN. Red flags in patients presenting with headache: clinical indications for neuroimaging. Br J Radiol. 2003;76(908):532-535. (Retrospective chart review)
  29. Bigal ME, Lipton RB. The prognosis of migraine. Curr Opin Neurol. 2008;21(3):301-308. (Review)
  30. Chakravarty A, Mukherjee A, Roy D. Migraine pain location: how do children differ from adults? J Headache Pain. 2008;9(6):375-379. (Prospective comparative study; 1000 patients)
  31. Wöber-Bingöl C, Wöber C, Karwautz A, et al. Diagnosis of headache in childhood and adolescence: a study in 437 patients. Cephalalgia. 1995;15(1):13-21. (Questionnaire)
  32. Senbil N, Gurer YK, Uner C, et al. Sinusitis in children and adolescents with chronic or recurrent headache: a casecontrol study. J Headache Pain. 2008;9(1):33-36. (Prospective case-control series; 310 patients)
  33. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112. (Review)
  34. Lumba A, Schnadower D, Joseph M. Evidence-based assessment and management of pediatric mild traumatic brain injury. Pediatric Emergency Medicine Practice. 2011;8(11):20. (Review)
  35. Ozge A, Termine C, Antonaci F, et al. Overview of diagnosis and management of paediatric headache. Part I: diagnosis. J Headache Pain. 2011;12(1):13-23. (Review)
  36. Abu-Arafeh I. Chronic tension-type headache in children and adolescents. Cephalalgia. 2001;21(8):830-836. (Prospective; 115 patients)
  37. Sempere AP, Porta-Etessam J, Medrano V, et al. Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia. 2005;25(1):30-35. (Prospective cohort study; 1876 patients)
  38. Schwedt TJ, Guo Y, Rothner AD. “Benign” imaging abnormalities in children and adolescents with headache. Headache. 2006;46(3):387-398. (Retrospective chart review; 681 patients)
  39. No authors listed. The epidemiology of headache among children with brain tumor. Headache in children with brain tumors. The Childhood Brain Tumor Consortium. J Neurooncol. 1991;10(1):31-46. (Epidemiologic study; 3291 patients)
  40. Honig PJ, Charney EB. Children with brain tumor headaches. Distinguishing features. Am J Dis Child. 1982;136(2):121-124. (Retrospective chart review; 72 patients)
  41. Wilne SH, Ferris RC, Nathwani A, et al. The presenting features of brain tumours: a review of 200 cases. Arch Dis Child. 2006;91(6):502-506. (Review)
  42. National Guideline. ACR Appropriateness Criteria®; headache -- child. Available at: http://www.guidelines.gov/content. aspx?id=37921&search=pediatric+headache. Accessed January 2, 2013. (Expert consensus; national guideline)
  43. Rozovsky K, Ventureyra EC, Miller E. Fast-brain MRI in children is quick, without sedation, and radiation-free, but beware of limitations. J Clin Neurosci. 2013;20(3):400-405. (Retrospective review; 50 reviews, 30 patients)
  44. Vanmolkot KR, Kors EE, Turk U, et al. Two de novo mutations in the Na,K-ATPase gene ATP1A2 associated with pure familial hemiplegic migraine. Eur J Hum Genet. 2006;14(5):555-560. (Observational study)
  45. Perry JJ, Spacek A, Forbes M, et al. Is the combination of negative computed tomography result and negative lumbar puncture result sufficient to rule out subarachnoid hemorrhage? Ann Emerg Med. 2008;51(6):707-713. (Prospective cohort study; 592 patients)
  46. McCormack RF, Hutson A. Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan? Acad Emerg Med. 2010;17(4):444-451. (Review)
  47. Martens D, Oster I, Gottschlling S, et al. Cerebral MRI and EEG studies in the initial management of pediatric headaches. Swiss Med Wkly. 2012;142:w13625. (Letter to the editor; 209 patients)
  48. Lewis DW, Ashwal S, Dahl G, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;59(4):490-498. (Review)
  49. Ozkan M, Teber ST, Deda G. Electroencephalogram variations in pediatric migraines and tension-type headaches. Pediatr Neurol. 2012;46(3):154-157. (Prospective cohort study; 100 patients)
  50. Papetti L, Nicita F, Parisi P, et al. “Headache and epilepsy” — how are they connected? Epilepsy Behav. 2013;26(3):386- 393. (Review)
  51. Sun-Edelstein C, Mauskop A. Complementary and alternative approaches to the treatment of tension-type headache. Curr Pain Headache Rep. 2012;16(6):539-544. (Review)
  52. Blumenthal HJ, Weisz MA, Kelly KM, et al. Treatment of primary headache in the emergency department. Headache. 2003;43(10):1026-1031. (Prospective cohort study; 57 patients)
  53. Lewis D, Ashwal S, Hershey A, et al. Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology. 2004;63(12):2215-2224. (Review)
  54. Hamalainen ML, Hoppu K, Valkeila E, et al. Ibuprofen or acetaminophen for the acute treatment of migraine in children: a double-blind, randomized, placebo-controlled, crossover study. Neurology. 1997;48(1):103-107. (Randomized doubleblind placebo-controlled trial; 88 patients)
  55. Lewis DW, Kellstein D, Dahl G, et al. Children’s ibuprofen suspension for the acute treatment of pediatric migraine. Headache. 2002;42(8):780-786. (Prospective double-blind placebo-controlled parallel group randomized study; 138 patients)
  56. Brousseau DC, Duffy SJ, Anderson AC, et al. Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac. Ann Emerg Med. 2004;43(2):256-262. (Prospective randomized, double-blind clinical trial; 62 patients)
  57. Trottier ED, Bailey B, Lucas N, et al. Prochlorperazine in children with migraine: a look at its effectiveness and rate of akathisia. Am J Emerg Med. 2012;30(3):456-463. (Prospective cohort; 79 patients)
  58. Kabbouche MA, Vockell AL, LeCates SL, et al. Tolerability and effectiveness of prochlorperazine for intractable migraine in children. Pediatrics. 2001;107(4):E62. (Retrospective chart review; 20 patients)
  59. Leung S, Bulloch B, Young C, et al. Effectiveness of standardized combination therapy for migraine treatment in the pediatric emergency department. Headache. 2013;53(3):491- 197. (Retrospective chart review; 252 patients)
  60. Linder SL, Mathew NT, Cady RK, et al. Efficacy and tolerability of almotriptan in adolescents: a randomized, doubleblind, placebo-controlled trial. Headache. 2008;48(9):1326- 1336. (Randomized double-blind placebo-controlled trial; 866 patients)
  61. Ueberall MA, Wenzel D. Intranasal sumatriptan for the acute treatment of migraine in children. Neurology. 1999;52(7):1507- 1510. (Randomized double-blind placebo-controlled crossover study; 14 patients)
  62. Ahonen K, Hamalainen ML, Rantala H, et al. Nasal sumatriptan is effective in treatment of migraine attacks in children: a randomized trial. Neurology. 2004;62(6):883-887. (Double-blind placebo-controlled 2-way crossover trial; 94 patients)
  63. Winner P, Rothner AD, Saper J, et al. A randomized, doubleblind, placebo-controlled study of sumatriptan nasal spray in the treatment of acute migraine in adolescents. Pediatrics. 2000;106(5):989-997. (Randomized double-blind placebocontrolled single-attack study; 653 patients)
  64. Ahonen K, Hamalainen ML, Eerola M, et al. A randomized trial of rizatriptan in migraine attacks in children. Neurology. 2006;67(7):1135-1140. (Double-blind placebo-controlled 2-way crossover trial; 94 patients)
  65. Lewis DW, Winner P, Hershey AD, et al. Efficacy of zolmitriptan nasal spray in adolescent migraine. Pediatrics. 2007;120(2):390-396. (Randomized double-blind placebocontrolled crossover study; 248 patients)
  66. Evers S, Rahmann A, Kraemer C, et al. Treatment of childhood migraine attacks with oral zolmitriptan and ibuprofen. Neurology. 2006;67(3):497-499. (Double-blind randomized placebo-controlled crossover trial; 32 patients)
  67. Kabbouche MA, Powers SW, Segers A, et al. Inpatient treatment of status migraine with dihydroergotamine in children and adolescents. Headache. 2009;49(1):106-109. (Retrospective chart review; 32 patients)
  68. Hamalainen ML, Hoppu K, Santavuori PR. Oral dihydroergotamine for therapy-resistant migraine attacks in children. Pediatr Neurol. 1997;16(2):114-117. (Double-blind placebocontrolled crossover study; 12 patients)
  69. Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache. 1991;31(5):298-301. (Double-blind placebo controlled study; 20 patients)
  70. Peikert A, Wilimzig C, Kohne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia. 1996;16(4):257-263. (Prospective multicenter placebo-controlled double-blind randomized study; 81 patients)
  71. Wang F, Van Den Eeden SK, Ackerson LM, et al. Oral magnesium oxide prophylaxis of frequent migrainous headache in children: a randomized, double-blind, placebo-controlled trial. Headache. 2003;43(6):601-610. (Randomized doubleblind placebo-controlled parallel-group trial; 118 patients)
  72. Pfaffenrath V, Wessely P, Meyer C, et al. Magnesium in the prophylaxis of migraine--a double-blind placebo-controlled study. Cephalalgia. 1996;16(6):436-440. (Prospective randomized double-blind placebo-controlled study; 150 patients)
  73. Kelley NE, Tepper DE. Rescue therapy for acute migraine, part 1: triptans, dihydroergotamine, and magnesium. Headache. 2012;52(1):114-128. (Review)
  74. Mathew NT, Kailasam J, Meadors L, et al. Intravenous valproate sodium (depacon) aborts migraine rapidly: a preliminary report. Headache. 2000;40(9):720-723. (Open-label prospective cohort study; 61 patients)
  75. Edwards KR, Norton J, Behnke M. Comparison of intravenous valproate versus intramuscular dihydroergotamine and metoclopramide for acute treatment of migraine headache. Headache. 2001;41(10):976-980. (Open-label randomized control trial; 40 patients)
  76. Tanen DA, Miller S, French T, et al. Intravenous sodium valproate versus prochlorperazine for the emergency department treatment of acute migraine headaches: a prospective, randomized, double-blind trial. Ann Emerg Med. 2003;41(6):847-853. (Randomized prospective double-blind trial; 40 patients)
  77. Kelley NE, Tepper DE. Rescue therapy for acute migraine, part 2: neuroleptics, antihistamines, and others. Headache. 2012;52(2):292-306. (Review)
  78. Kelley NE, Tepper DE. Rescue therapy for acute migraine, part 3: opioids, NSAIDs, steroids, and post-discharge medications. Headache. 2012;52(3):467-482. (Review)
  79. Anttila P. Tension-type headache in childhood and adolescence. Lancet Neurol. 2006;5(3):268-274. (Review)
  80. Bennett MH, French C, Schnabel A, et al. Normobaric and hyperbaric oxygen therapy for migraine and cluster headache. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005219. (Systematic review; 9 trials, 201 patients)
  81. Law S, Derry S, Moore RA. Triptans for acute cluster headache. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD008042. (Systematic review of 6 randomized control trials; 10,918 patients)
  82. Mariani R, Capuano A, Torriero R, et al. Cluster headache in childhood: case series from a pediatric headache center. J Child Neurol. 2013 Jan 9. [Epub ahead of print] (Retrospective case series; 11 patients)
  83. Robbins L. Intranasal lidocaine for cluster headache. Headache. 1995;35(2):83-84.
  84. Hayward G, Heneghan C, Perera R, et al. Intranasal corticosteroids in management of acute sinusitis: a systematic review and meta-analysis. Ann Fam Med. 2012;10(3):241-249. (Systematic review and meta-analysis; 6 studies, 2495 patients)
  85. De Felice M, Ossipov M, Porreca F. Update on medicationoveruse headache. Curr Pain Headache Rep. 2011;15(1):79-83. (Expert opinion)
  86. Silberstein SD, Olesen J, Bousser MG, et al. The international classification of headache disorders, 2nd edition (ICHD-II)- -revision of criteria for 8.2 medication-overuse headache. Cephalalgia. 2005;25(6):460-465. (Review)
  87. Rabe K, Pageler L, Gaul C, et al. Prednisone for the treatment of withdrawal headache in patients with medication overuse headache: a randomized, double-blind, placebo-controlled study. Cephalalgia. 2013;33(3):202-207. (Randomized doubleblind placebo-controlled study; 96 patients)
  88. Halker RB, Dilli E. A role for steroids in treating medication overuse headache? Cephalalgia. 2013;33(3):149-151. (Editorial)
  89. Biousse V, Bruce BB, Newman NJ. Update on the pathophysiology and management of idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry. 2012;83(5):488-494.
  90. Basurto Ona X, Martínez García L, Solà I, et al. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2013 Feb 28;2:CD001792. (Systematic review; 7 randomized control trials, 200 patients)
  91. Afridi SK, Giffin NJ, Kaube H, et al. A randomized controlled trial of intranasal ketamine in migraine with prolonged aura. Neurology. 2013;80(7):642-647. (Double-blinded randomized parallel-group controlled study; 18 patients)
  92. Sheridan DC, Spiro DM, Nguyen T, et al. Low-dose propofol for the abortive treatment of pediatric migraine in the emergency department. Pediatr Emerg Care. 2012;28(12):1293-1296. (Retrospective chart review)
  93. Krusz JC, Scott V, Belanger J. Intravenous propofol: unique effectiveness in treating intractable migraine. Headache. 2000;40(3):224-230. (Observation of 77 patients in pain clinic setting)
  94. Termine C, Özge A, Antonaci F, et al. Overview of diagnosis and management of paediatric headache. Part II: therapeutic management. J Headache Pain. 2011;12(1):25-34. (Review)
  95. Brna P, Dooley J, Gordon K, et al. The prognosis of childhood headache: a 20-year follow-up. Arch Pediatr Adolesc Med. 2005;159(12):1157-1160. (Prospective cohort study; 95 patients)
  96. Ozge A, Sasmaz T, Cakmak SE, et al. Epidemiological-based childhood headache natural history study: after an interval of six years. Cephalalgia. 2010;30(6):703-712. (Epidemiologic follow-up study; 1155 patients)
  97. Babineau SE, Green MW. Headaches in children. Continuum (Minneap Minn). 2012;18(4):853-868. (Review)
  98. Bailey JE, Wan JY, Mabry LM, et al. Does health information exchange reduce unnecessary neuroimaging and improve quality of headache care in the emergency department? J Gen Intern Med. 2013;28(2):176-183. (Prospective longitudinal data analysis; 2102 patients)
Already purchased this course?
Log in to read.
Purchase a subscription

Price: $449/year

140+ Credits!

Money-back Guarantee
Publication Information
Authors

Michael J. Alfonzo, MD, MS; Kirsten Bechtel, MD; Shannon Babineau, MD

Publication Date

July 1, 2013

Get Permission

Get A Sample Issue Of Emergency Medicine Practice
Enter your email to get your copy today! Plus receive updates on EB Medicine every month.
Please provide a valid email address.