Ophthalmologic Manifestations of Pediatric Headache Workup

  • Author: Marc E Lenaerts, MD, FAHS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jan 27, 2010
 

Laboratory Studies

  • Routine CBC and chemistries can help on an individual basis when specific etiologies, such as infection, are considered; however, they rarely are indicated.
Next

Imaging Studies

  • Neuroimaging usually is not indicated for the routine care of patients with headache except may be in the very young child and if absolutely no family history can be found despite thorough review. However, according to a study of over 700 children by Graf et al, there appears to be an increase in the rate at which neuroimaging is being ordered by primary care physicians.[26]
Previous
Next

Other Tests

  • Clinical neurophysiologic testing has little to offer in clinical practice contrary to research.
Previous
Next

Procedures

  • Consider spinal tap specifically if meningitis is suspected. Cerebrospinal fluid (CSF) studies should include a measure of pressure, CBC, protein, glucose (always correlate with blood glucose), and microbiology. A tap also can give a CSF pressure value in case benign intracranial hypertension is considered.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Marc E Lenaerts, MD, FAHS  Staff Neurologist, Mercy Medical Group, Sacramento, CA; Associate Clinical Professor of Neurology, Department of Neurology, University of California at Davis, Sacramento

Marc E Lenaerts, MD, FAHS is a member of the following medical societies: American Academy of Neurology, American Headache Society, and International Headache Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Bartiss, OD, MD  Medical Director, Ophthalmology, Family Eye Care of the Carolinas

Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, and North Carolina Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Brian R Younge, MD  Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Bailey B, McManus BC. Treatment of children with migraine in the emergency department: a qualitative systematic review. Pediatr Emerg Care. May 2008;24(5):321-30. [Medline].

  2. Walker DM, Teach SJ. Emergency department treatment of primary headaches in children and adolescents. Curr Opin Pediatr. Jun 2008;20(3):248-54. [Medline].

  3. Vanmolkot KR, Kors EE, Turk U, Turkdogan D, Keyser A, Broos LA, et al. Two de novo mutations in the Na,K-ATPase gene ATP1A2 associated with pure familial hemiplegic migraine. Eur J Hum Genet. May 2006;14(5):555-60. [Medline].

  4. Dichgans M, Freilinger T, Eckstein G, Babini E, Lorenz-Depiereux B, Biskup S, et al. Mutation in the neuronal voltage-gated sodium channel SCN1A in familial hemiplegic migraine. Lancet. Jul 30-Aug 5 2005;366(9483):371-7. [Medline].

  5. Ducros A, Joutel A, Vahedi K, et al. Mapping of a second locus for familial hemiplegic migraine to 1q21-q23 and evidence of further heterogeneity. Ann Neurol. Dec 1997;42(6):885-90. [Medline].

  6. Gardner K, Barmada MM, Ptacek LJ, Hoffman EP. A new locus for hemiplegic migraine maps to chromosome 1q31. Neurology. Nov 1997;49(5):1231-8. [Medline].

  7. Split W, Neuman W. Epidemiology of migraine among students from randomly selected secondary schools in Lodz. Headache. Jul-Aug 1999;39(7):494-501. [Medline].

  8. Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, Prensky A. 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. Aug 27 2002;59(4):490-8. [Medline].

  9. Bille B. Migraine in childhood. In: Lanzi G, Ballotin U, Cernibori A, eds. Headache in Children and Adolescents. Amsterdam:. Elsevier Science Publishers;1989:19-26.

  10. Bille B. 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. 1962;51:1-151.

  11. Sillanpaa M. Changes in the prevalence of migraine and other headaches during the first seven school years. Headache. Jan 1983;23(1):15-9. [Medline].

  12. Sillanpaa M. Prevalence of headache in prepuberty. Headache. Jan 1983;23(1):10-4. [Medline].

  13. Brna P, Dooley J, Gordon K et al. The prognosis of childhood headache: a 20-year follow-up. Arch Pediatr Adolesc Med. 2005;159:1157-60. [Medline].

  14. Hershey AD, Powers SW, Vockell AL, LeCates SL, Segers A, Kabbouche MA. Development of a patient-based grading scale for PedMIDAS. Cephalalgia. Oct 2004;24(10):844-9. [Medline].

  15. Battistutta S, Aliverti R, Montico M, Zin R, Carrozzi M. Chronic tension-type headache in adolescents. Clinical and psychological characteristics analyzed through self- and parent-report questionnaires. J Pediatr Psychol. Aug 2009;34(7):697-706. [Medline].

  16. Hamalainen ML, Hoppu K, Santavuori PR. Effect of age on the fulfillment of the IHS criteria for migraine in children at a headache clinic. Cephalalgia. Oct 1995;15(5):404-9. [Medline].

  17. Headache Classification Committee of the IHS. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia. 1988;8 Suppl 7:1-96. [Medline].

  18. Lima MM, Padula NA, Santos LC et al. Critical analysis of the international classification of headache disorders diagnostic criteria (ICHD I-1988) and (ICHD II-2004), for migraine in children and adolescents. Cephalalgia. 2005;25:1042-7. [Medline].

  19. Metshonkala L, Sillanpaa M. Classification of headache and migraine in children.Proceedings of the 3rd Congress on Headache in Childhood and Adolescence; Hungary, Budapest, May 1995. Cephalalgia. 1995;15(S16):7.

  20. Wober-Bingol C, Wober C, Karwautz A, et al. Diagnosis of headache in childhood and adolescence: a study in 437 patients. Cephalalgia. Feb 1995;15(1):13-21; discussion 4. [Medline].

  21. Chakravarty A, Mukherjee A, Roy D. Migraine pain location: how do children differ from adults?. J Headache Pain. Dec 2008;9(6):375-9. [Medline].

  22. deGrauw TJ, Hershey AD, Powers SW, Bentti AL. Diagnosis of migraine in children attending a pediatric headache clinic. Headache. Jul-Aug 1999;39(7):481-5. [Medline].

  23. Winner P, Martinez W, Mate L, Bello L. Classification of pediatric migraine: proposed revisions to the IHS criteria. Headache. Jul-Aug 1995;35(7):407-10. [Medline].

  24. Osterhaus JT, Townsend RJ, Gandek B, Ware JE Jr. Measuring the functional status and well-being of patients with migraine headache. Headache. Jun 1994;34(6):337-43. [Medline].

  25. Powers SW, Patton SR, Hommel KA, Hershey AD. Quality of life in paediatric migraine: characterization of age-related effects using PedsQL 4.0. Cephalalgia. Feb 2004;24(2):120-7. [Medline].

  26. Graf WD, Kayyali HR, Alexander JJ, Simon SD, Morriss MC. Neuroimaging-use trends in nonacute pediatric headache before and after clinical practice parameters. Pediatrics. Nov 2008;122(5):e1001-5. [Medline].

  27. Wöber C, Wöber-Bingöl C. Clinical management of young patients presenting with headache. Funct Neurol. 2000;15 Suppl 3:89-105. [Medline].

  28. Termine C, Ferri M, Balottin U. Acute treatment of migraine in children and adolescents. Funct Neurol. Apr-Jun 2008;23(2):63-9. [Medline].

  29. Boyle R, Behan PO, Sutton JA. A correlation between severity of migraine and delayed gastric emptying measured by an epigastric impedance method. Br J Clin Pharmacol. Sep 1990;30(3):405-9. [Medline].

  30. Ahonen K, Hämäläinen ML, Rantala H, Hoppu K. Nasal sumatriptan is effective in treatment of migraine attacks in children: A randomized trial. Neurology. Mar 23 2004;62(6):883-7. [Medline].

  31. Andrasik F, Blanchard EB, Neff DF, Rodichok LD. Biofeedback and relaxation training for chronic headache: a controlled comparison of booster treatments and regular contacts for long-term maintenance. J Consult Clin Psychol. Aug 1984;52(4):609-15. [Medline].

  32. Barlow CF. Headache in childhood. In: Barlow CF, ed. Headaches and Migraine in Childhood. London:. Spa Int Publisher;1984:11-13.

  33. Bickerstaff ER. Basilar artery migraine. Lancet. 1961;1:15-17.

  34. Bousser MG. Migraine, female hormones, and stroke. Cephalalgia. Mar 1999;19(2):75-9. [Medline].

  35. Bruni O, Fabrizi P, Ottaviano S, et al. Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study. Cephalalgia. Jun 1997;17(4):492-8. [Medline].

  36. Cady RK, Sheftell F, Lipton RB, et al. Effect of early intervention with sumatriptan on migraine pain: retrospective analyses of data from three clinical trials. Clin Ther. Sep 2000;22(9):1035-48. [Medline].

  37. Caruso JM, Brown WD, Exil G, Gascon GG. The efficacy of divalproex sodium in the prophylactic treatment of children with migraine. Headache. Sep 2000;40(8):672-6. [Medline].

  38. Chu ML, Shinnar S. Headaches in children younger than 7 years of age. Arch Neurol. Jan 1992;49(1):79-82. [Medline].

  39. Couch JR, Ziegler DK, Hassanein R. Amitriptyline in the prophylaxis of migraine. Effectiveness and relationship of antimigraine and antidepressant effects. Neurology. Feb 1976;26(2):121-7. [Medline].

  40. Cuvellier JC, Donnet A, Guégan-Massardier E, Nachit-Ouinekh F, Parain D, Vallée L. Clinical features of primary headache in children: a multicentre hospital-based study in France. Cephalalgia. Nov 2008;28(11):1145-53. [Medline].

  41. Deonna T, Martin D. Benign paroxysmal torticollis in infancy. Arch Dis Child. Dec 1981;56(12):956-9. [Medline].

  42. Eeg-Olofsson O, Odkvist L, Lindskog U, Andersson B. Benign paroxysmal vertigo in childhood. Acta Otolaryngol. Mar-Apr 1982;93(3-4):283-9. [Medline].

  43. Evers S, Rahmann A, Kraemer C, Kurlemann G, Debus O, Husstedt IW, et al. Treatment of childhood migraine attacks with oral zolmitriptan and ibuprofen. Neurology. Aug 8 2006;67(3):497-9. [Medline].

  44. Fleisher DR, Gornowicz B, Adams K et al. Cyclic vomiting syndrome in 41 adults: the illness, the patients and problems of management. BMC Med. 2005;3:20. [Medline].

  45. Gallelli L, Iannacchero R, De Caro E et al. A questionnaire-based study on prevalence and treatment of headache in young children. J Headache Pain. 2005;6:277-80. [Medline].

  46. Hering R, Kuritzky A. Sodium valproate in the prophylactic treatment of migraine: a double- blind study versus placebo. Cephalalgia. Apr 1992;12(2):81-4. [Medline].

  47. Hershey AD, Powers SW, Nelson TD, Kabbouche MA, Winner P, Yonker M. Obesity in the pediatric headache population: a multicenter study. Headache. Feb 2009;49(2):170-7. [Medline].

  48. Hockaday JM, Barlow CF. Headache in children. In: Olesen J, Tfelt-Hansen P, Welch KMA, eds. The Headaches. New York:. Raven Press;1993:802-808.

  49. Honig PJ, Charney EB. Children with brain tumor headaches. Distinguishing features. Am J Dis Child. Feb 1982;136(2):121-4. [Medline].

  50. Hämäläinen ML, Hoppu K, Santavuori P. Sumatriptan for migraine attacks in children: a randomized placebo-controlled study. Do children with migraine respond to oral sumatriptan differently from adults?. Neurology. Apr 1997;48(4):1100-3. [Medline].

  51. Hämäläinen ML, Hoppu K, Santavuori PR. Oral dihydroergotamine for therapy-resistant migraine attacks in children. Pediatr Neurol. Feb 1997;16(2):114-7. [Medline].

  52. Jay GW, Tomasi LG. Pediatric headaches: a one year retrospective analysis. Headache. Jan 1981;21(1):5-9. [Medline].

  53. Joutel A, Bousser MG, Biousse V, et al. A gene for familial hemiplegic migraine maps to chromosome 19. Nat Genet. Sep 1993;5(1):40-5. [Medline].

  54. Kabbouche MA, Gilman DK. Management of migraine in adolescents. Neuropsychiatr Dis Treat. Jun 2008;4(3):535-48. [Medline].

  55. Karwautz A, Wober C, Lang T, et al. Psychosocial factors in children and adolescents with migraine and tension-type headache: a controlled study and review of the literature. Cephalalgia. Jan 1999;19(1):32-43. [Medline].

  56. Kienbacher C, Wöber C, Zesch HE, Hafferl-Gattermayer A, Posch M, Karwautz A, et al. Clinical features, classification and prognosis of migraine and tension-type headache in children and adolescents: a long-term follow-up study. Cephalalgia. Jul 2006;26(7):820-30. [Medline].

  57. Korsgaard AG. The tolerability, safety and efficacy of oral Sumatriptan 50 mg and 100 mg for the acute treatment of migraine in adolescents.Proceedings of the 3rd Congress on Headache in Childhood and Adolescence. Vol 15. Budapest, Hungary:. 1995:99.

  58. Kruit MC, van Buchem MA, Hofman PA. Migraine as a risk factor for subclinical brain lesions. JAMA. Jan 28 2004;291(4):427-34. [Medline].

  59. Laurell K, Larsson B, Eeg-Olofsson O. Headache in schoolchildren: association with other pain, family history and psychosocial factors. Pain. Dec 15 2005;119(1-3):150-8. [Medline].

  60. Lenaerts M, Bastings E, Sianard J, Schoenen J. Sodium valproate in severe migraine and tension-type headache: an open study of long-term efficacy and correlation with blood levels. Acta Neurol Belg. Jun 1996;96(2):126-9. [Medline].

  61. Lenaerts ME. Alternative therapies for tension-type headache. Curr Pain Headache Rep. Dec 2004;8(6):484-8. [Medline].

  62. Lenaerts ME. Pharmacoprophylaxis of tension-type headache. Curr Pain Headache Rep. Dec 2005;9(6):442-7. [Medline].

  63. Levine HL, Setzen M, Cady RK, Dodick DW, Schreiber CP, Eross EJ, et al. An otolaryngology, neurology, allergy, and primary care consensus on diagnosis and treatment of sinus headache. Otolaryngol Head Neck Surg. Mar 2006;134(3):516-23. [Medline].

  64. Lewis DW. Toward the definition of childhood migraine. Curr Opin Pediatr. 2004;16:628-36. [Medline].

  65. Lewis DW, Dorbad D. The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache. Sep 2000;40(8):629-32. [Medline].

  66. Lewis DW, Kellstein D, Dahl G, Burke B, Frank LM, Toor S, et al. Children's ibuprofen suspension for the acute treatment of pediatric migraine. Headache. Sep 2002;42(8):780-6. [Medline].

  67. Lewis DW, Yonker M, Winner P et al. The treatment of pediatric migraine. Pediatr Ann. 2005;34:448-60. [Medline].

  68. Luc ME, Gupta A, Birnberg JM et al. Characterization of symptoms of sleep disorders in children with headaches. Pediatr Neurol. 2006;34:7-12. [Medline].

  69. Metsahonkala L, Sillanpaa M, Tuominen J. Outcome of early school-age migraine. Cephalalgia. Oct 1997;17(6):662-5. [Medline].

  70. Moskowitz MA. Neurogenic versus vascular mechanisms of sumatriptan and ergot alkaloids in migraine. Trends Pharmacol Sci. Aug 1992;13(8):307-11. [Medline].

  71. Nyholt DR, Dawkins JL, Brimage PJ, Schoenen J. Evidence for an X-linked genetic component in familial typical migraine. Hum Mol Genet. Mar 1998;7(3):459-63. [Medline].

  72. Olesen J. Migraine aura and its subforms. In: Olesen J, Tfelt-Hansen P, Welch KMA, eds. The Headaches. New York:. Raven Press;1993:263-275.

  73. Prensky AL, Sommer D. Diagnosis and treatment of migraine in children. Neurology. Apr 1979;29(4):506-10. [Medline].

  74. Rock G, Smiley RK, Tittley P, Palmer DS. In vivo effectiveness of a high-yield factor VIII concentrate prepared in a blood bank. N Engl J Med. Aug 2 1984;311(5):310-3. [Medline].

  75. Rothner AD. Headaches in children and adolescents. Child Adolesc Psychiatr Clin N Am. Oct 1999;8(4):727-45. [Medline].

  76. Scalas C, Calistri L. Chronic daily headache in a paediatric headache centre. J Headache Pain. Sep 2005;6(4):274-6. [Medline].

  77. Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology. Feb 1998;50(2):466-70. [Medline].

  78. Schoenen J, Sianard-Gainko J, Lenaerts M. Blood magnesium levels in migraine. Cephalalgia. May 1991;11(2):97-9. [Medline].

  79. Sorge F, De Simone R, Marano E, et al. Flunarizine in prophylaxis of childhood migraine. A double-blind, placebo-controlled, crossover study. Cephalalgia. Mar 1988;8(1):1-6. [Medline].

  80. Starfield B, Katz H, Gabriel A, et al. Morbidity in childhood--a longitudinal view. N Engl J Med. Mar 29 1984;310(13):824-9. [Medline].

  81. Ueberall MA, Wenzel D. Intranasal sumatriptan for the acute treatment of migraine in children. Neurology. Apr 22 1999;52(7):1507-10. [Medline].

  82. Vahlquist B, Hackzell G. Migraine of early onset: a study of 31 cases in which the disease first appeared between one and four years of age. Acta Pediatrica. 1949;38:622-636.

  83. Vendrame M, Kaleyias J, Valencia I, Legido A, Kothare SV. Polysomnographic findings in children with headaches. Pediatr Neurol. Jul 2008;39(1):6-11. [Medline].

  84. Verhagen AP, Damen L, Berger MY et al. Conservative treatments of children with episodic tension-type headache. A systematic review. J Meurol. 2005;252:1147-54. [Medline].

  85. Visser WH, Winner P, Strohmaier K, Klipfel M, Peng Y, McCarroll K, et al. Rizatriptan 5 mg for the acute treatment of migraine in adolescents: results from a double-blind, single-attack study and two open-label, multiple-attack studies. Headache. Oct 2004;44(9):891-9. [Medline].

  86. Watson P, Steele JC. Paroxysmal disequilibrium in the migraine syndrome of childhood. Arch Otolaryngol. Mar 1974;99(3):177-9. [Medline].

  87. Winner P. Pediatric headaches: what's new?. Curr Opin Neurol. Jun 1999;12(3):269-72. [Medline].

  88. Winner P, Lewis D, Visser WH, Jiang K, Ahrens S, Evans JK. Rizatriptan 5 mg for the acute treatment of migraine in adolescents: a randomized, double-blind, placebo-controlled study. Headache. Jan 2002;42(1):49-55. [Medline].

  89. Winner P, Linder SL, Lipton RB, Almas M, Parsons B, Pitman V. Eletriptan for the acute treatment of migraine in adolescents: results of a double-blind, placebo-controlled trial. Headache. Apr 2007;47(4):511-8. [Medline].

  90. [Best Evidence] Winner P, Pearlman EM, Linder SL et al. Topiramate for migraine prevention in children: a randomized, double-blind, placebo-controlled trial. Headache. 2005;45:1304-12. [Medline].

  91. Winner P, Rothner AD, Saper J, Nett R, Asgharnejad M, Laurenza A, et al. A randomized, double-blind, placebo-controlled study of sumatriptan nasal spray in the treatment of acute migraine in adolescents. Pediatrics. Nov 2000;106(5):989-97. [Medline].

  92. [Best Evidence] Winner P, Rothner AD, Wooten JD, Webster C, Ames M. Sumatriptan nasal spray in adolescent migraineurs: a randomized, double-blind, placebo-controlled, acute study. Headache. Feb 2006;46(2):212-22. [Medline].

  93. Yarnitsky D, Goor-Aryeh I, Bajwa ZH. 2003 Wolff Award: Possible parasympathetic contributions to peripheral and central sensitization during migraine. Headache. Jul-Aug 2003;43(7):704-14. [Medline].

 
Previous
Next
 
Trigeminovascular system.The trigeminal nerve fibers around basal cerebral and meningeal vessels are triggered (various stimuli are possible), and a vicious circle starts where the nerve terminals release calcitonin gene-related peptide (CGRP), substance P, vasoinhibitory peptide (VIP), and other mediators of local neurogenic inflammation and vasodilatation. The latter further stimulates the nerve endings. On the other end of the nerve, painful messages are transmitted toward central centers, including thalamus and cortex, and the sensation of pain arises.Modern drugs, such as the triptans, act at 3 levels, via 5-HT 1 B and D receptors; they vasoconstrict the vessels, they reduce the release of the above-mentioned mediators, and they decrease the central transmission of pain impulses.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.