Recurrent Headaches In Children
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan in Diagnosing and Treating Common Problems in Paediatrics, 2017
Migraine affects 3%–10% of children. Twenty per cent may experience their first attack prior to 5 years of age. The incidence increases steadily with age, affecting boys and girls equally before puberty, and girls more commonly thereafter. Migraine is characterised by episodes of head pain that is always throbbing and frequently unilateral frontal or temporal in position. Pallor is a prominent feature and the child may be described as being ‘ghostly pale’. Most children with significant migraine stop what they are doing and go to a darkened room, lie down and fall asleep. The headache is often gone on awakening. Headache due to migraine lasts over 3 hours and <72 hours (status migrainous is >72 hours in duration and needs emergency management). Acute migraine is of relatively sudden onset, and can occur with or without a prodrome – also known as aura.
Ocular manifestations of systemic disease
Mary E. Shaw, Agnes Lee in Ophthalmic Nursing, 2018
Migraine is a severe headache giving rise to a number of symptoms including nausea and visual problems. Migraine can be triggered by certain factors such as drinking alcohol and coffee, a lack of sleep, high stress levels and eating cheese. There are two different types of migraine – classical migraine when a patient experiences a headache follows a series of symptoms known as aura and common migraine with no aura symptoms. Patients suffering from classical migraine may present themselves to the Emergency Eye Centre with visual problems such as flashing lights, visual distortions and seeing zigzag patterns. They may also be complaining of neck stiffness, nausea, problems with coordination and speech difficulty. General measures include eliminating other causes of symptoms and establishing the diagnosis of migraine. Once the diagnosis has been established, treatment such as simple analgesia and anti-emetic can be given if appropriate. Advice including elimination of known conditions that may precipitate an attack should be provided.
Migraine: diagnosis and treatment
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache in Clinical Practice, 2018
Status migrainosus is an attack of migraine, the headache phase of which lasts more than 72 hours whether it is treated or not.8 It is characterized by the severe, persistent headache often associated with intractable nausea and vomiting. Factors responsible for triggering status migrainosus include emotional stress, depression, abuse of medications, anxiety, diet, hormonal factors, and multiple nonspecific factors.126 Status migrainosus may be secondary to an acute neurologic disorder. Prior to instituting treatment, serious organic causes of headache must be excluded.126 Patients with status migrainosus need aggressive treatment. They usually present in the emergency department, but can be treated in outpatient infusion centers. The principles of treatment for status migrainosus include: Fluid and electrolyte replacement (if indicated);Drug detoxification;Intravenous pharmacotherapy to control pain;Treatment of associated symptoms of nausea andvomiting; andConcurrent implementation of migraineprophylaxis (if indicated).
A device review of Relivion®: an external combined occipital and trigeminal neurostimulation (eCOT-NS) system for self-administered treatment of migraine and major depressive disorder
Published in Expert Review of Medical Devices, 2021
Oved Daniel, Roni Sharon, Stewart J. Tepper
Patients with migraine complain of headaches, reported as pain, pressure, or both, as well as associated symptoms such as sensitivity to light and/or sound and nausea. The intensity, frequency, and duration of patients’ symptoms may vary between migraine episodes. The location of the perceived pain may vary as well between episodes, and can be unilateral, bilateral, frontal, posterior, or global [22,23]. Migraine-associated differences in location and fluctuation of severity have been defined as dysregulated sensory thresholds [22]. According to this notion, migraines are characterized by a change in excitability thresholds, which tend to increase or decrease even within the same individual, as a function of the migraine cycle phase. Furthermore, following this variance, stimulation efficacy is optimal when administered in accordance with the current spatial distribution of pain during an episode. Due to this instability, adequate excitation of different locations, such as the right and left sides of the trigeminal nerve branches, requires a separate PNS channel for each location.
Dysautonomia in the pathogenesis of migraine
Published in Expert Review of Neurotherapeutics, 2018
Parisa Gazerani, Brian Edwin Cairns
ANS-related symptoms in migraine often include nausea, vomiting, diarrhea, polyuria, eyelid edema, conjunctival injection, lacrimation, nasal congestion, and ptosis [19]. In addition, the throbbing nature of the headache pain has been proposed to reflect sensitization of the trigeminovascular pain pathway, which monitors cerebral vascular tone and sends information to the central nervous system [8,20]. Activation of descending hypothalamic projections to, for example, the superior salivatory nucleus (SSN) and locus coeruleus, which are involved in changes in parasympathetic and sympathetic tone, respectively, may underlie the autonomic symptoms reported during migraine headache [8,21]. Functional connectivity studies that used functional magnetic resonance imaging have yielded evidence for hypothalamic-mediated autonomic symptoms that accompany or precede migraine attacks [21].
Lasmiditan in patients with common migraine comorbidities: a post hoc efficacy and safety analysis of two phase 3 randomized clinical trials
Published in Current Medical Research and Opinion, 2020
David B. Clemow, Simin K. Baygani, Paula M. Hauck, Cory B. Hultman
Patients with migraine have higher risks of having other certain comorbid conditions that may have a negative impact on their treatment and ultimately migraine resolution. The current post hoc analyses evaluated the safety and efficacy of lasmiditan for treatment of a single migraine attack among patients with and without common comorbidities of migraine, as determined through literature review. The 13 Comorbidity Groups chosen were Anxiety, Allergy, Bronchial, Cardiac, Depression, Fatigue, Gastrointestinal, Hormonal, Musculoskeletal/pain, Neurological, Obesity, Sleep, and Vascular. Approximately, 80% of the patients in the pooled Phase 3 SAMURAI and SPARTAN study data used in the current analyses had at least one of these comorbidities and approximately 35% of the patients had 3 or more of the comorbidities (Table 2). These data confirm the accuracy of the common aspect of these conditions in patients with migraine.
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