Pediatric Headache in Emergency Medicine Treatment & Management

  • Author: Kirsten A Bechtel, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Mar 26, 2010
 

Emergency Department Care

  • Migraine and tension headache
    • The goals of therapy are to relieve pain, alleviate nausea, and promote sleep.
    • Vasoconstrictive agents may be helpful, especially if the onset of headache has been recent.
    • Narcotic and nonnarcotic analgesics, sedatives, and antiemetics are helpful adjunctive therapy.
  • The treatment of sinusitis includes appropriate antibiotic coverage, analgesics (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], acetaminophen), and nasal decongestants.
  • Head trauma, intracranial mass/abscess
    • In the event of intracranial hemorrhage or an intracranial mass causing headache, appropriate airway management, with the goal of adequate oxygenation and hyperventilation to reduce cerebral blood flow and lower intracranial pressure is the immediate goal. Subsequent surgery is necessary to evacuate the lesion.
    • Analgesics are useful for chronic postconcussive headaches.
  • To alleviate the increased intracranial pressure associated with pseudotumor cerebri, a lumbar puncture is used to reduce the volume of CSF. Carbonic anhydrase inhibitors decrease the production of CSF.
  • The treatment goal of meningeal inflammation is to treat the underlying cause, such as HTN (antihypertensives), infection (antibiotics), or subarachnoid hemorrhage (surgical evacuation of intracranial hemorrhage; nimodipine can be used to reduce vasospasm).
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Consultations

  • Consultation with a surgeon is appropriate for headache caused by mass lesions, intracranial hemorrhage, or abscess.
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Contributor Information and Disclosures
Author

Kirsten A Bechtel, MD  Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

William G Gossman, MD  Associate Clinical Professor of Emergency Medicine, Creighton University School of Medicine; Consulting Staff, Department of Emergency Medicine, Creighton University Medical Center

William G Gossman, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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