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patient this week is on headaches. I'm very happy to say that I'm being joined once again by doctor, and it's early side on Be will be taking on what is actually quite a while worrying topic for a lot of junior's. Because I had a chicken, you know, they range from very mild, not really a serious issue to actually something that's quite scary on a bubble Pedro, really to be managing on So But before we start, I just need to tell you a little bit about our sponsor you probably heard about before. If you if you've been on these webinars before, so it's going to CPD me on. This is a website that you can go on to. You can watch lots of lots of webinars. They're all CPD accredited, so you can put it in your portfolio. Um, you know, and that's the doctors, but also for nurses or anyone that needs to develop a professional portfolio on day 8 lbs a year. Answer that 50% discount you get using this QR code here on, I will post it later in the Facebook group for you to have a look at now. It is my absolute pleasure toe, hand over toe doctor site. Who is a consultant? Pediatrician in general, pediatrics on goin us a couple of weeks ago for a very informative talk. All about rashes. Teo. Yeah, under to see it, considering in addition here, that stroke Mandible Hospital, which using the Kingdom Child, England and double it up to be, is the discussion is headache, which is the second most common symptom after fever. Children on you conceding current availability of information on Google everywhere, didn't give, not off by itchy to repeat and as allowed to be doctors. And usually if the presentation. But patient is headache at the end of conservation, many time doctors every more medic than the centers. So this approach is little. Simply use a huge drop. Many books are written on headache, So in this green presentation, little guidance, how to approach the child will hurt it. So how hold the Children experienced one or more at the sort of headache by seven year of age, Most of it, you know, an experience headache by 15 years so you can save a 15 years. Every child knows what her kids only 5% of what you listen to suffer from wiki headaches, reverting in school absence and reduction in quality of life and headache is one of the most frequently reported illness. Intend to 24 years of age group having benign symptom with our your patient itself revolving and no underlying causes, detective sometimes it may be a manifestation of serious illness like meningitis. Brain tumor are interacting. Hemorrhage in emergency setting like patient brought me last night to hospital. 5% of patients have a serious neurological car, and very is that important. We should should be assessed very carefully, and the rep for diagnosis is but so starting the simple but off the allergy headache from it. This headache is coming. Is there pain in the green? You got green, the source up being bring urine came out. It's every don't demand like everything my land lining and are insensitive to being all the minute You except Duda are also insensitive to okay, headache is you do emulation off being receptors outside the actual brains off. What does the pain since the structure in the head and neck intercranial several and do her arteries Large Means and Venus Sciences. You're a matter at the base of Green. So these three structures are since you do pee been sent secure in the head and neck, extra three nerves and for like, a rooms except my arteries scan and muscles. A guy to skull other nasal sciences and middle ear very osteo. And he mechanism up being production dietician off intra bacteria in your arteries. Traction displacement of interpreting arteries and lord means, are their uterus envelopes. By use this off means compression traction are inflammation cranial. Our final normal rules spots, inflammation or trauma to create a lot of our markets. Right Muscles, Many MGs. Move your medication. These intraocular pressure are inappropriate activation of brain stem. Are we, In example, your vision is migraine and 40 in. Are you trigeminal? You're ready. Know the question of headed as the intensive structures are more respiratory later. So we have to see there is what blood vessel and what is the nurse lady of that? So this is this playoff Breen until several allergy is supplying at this period area of the brain, while the middle several Archies by most of the external, our little surface of green and computer, several are peas, lying d Inferior, selfless. Agree if you look inside. So this is this. Like you wanted into your several. The friend. One in middle, cerebral, very little part off inside the vents on Sundays. And the green one is the infusion center. No, not supply of the pain sensitive structure in the interrogation structures. In the support it a real vessel try. General number is enough. Like there are two deviations. You mean running? Tell me. Second is memory started Medical. All three are flying supratentorial vessels off every while. The infertility really lesser, which is in the posterior part of brain, are supplied by through. I can earn one toe entry. We were looking at her, you know, supply to the surface of head. So this is the idea where the pain will be left Word. So we wanted the first being a trident like Tell McVean. Me too. Is the magnet to be in on me. To use it mandibular to be while back of the head and neck is right by survival. No, no classification of hurting. You probably had a kid with no underlying cause. Most common in detention. Heavy duty, 69%. Migraine is 16% you, but extending one type of sharp headings. 2% cholesterol. Headache is only open 1% while virginal headache in one person. But secondly, headache really is underlying structure. Are infection systemic infection called 63%? How did you make out for person? Wrestler disorder can cause 1%. Some organ hemorrhage left in 1% and brain tumor 10.1 approach. And Agnes is so, like all the medical condition, the broaches, history, physical examination and investigation. But in headache, history is the most important because whatever the physical examination investigation are, mostly D's are unremarkable. So you don't find any far in physical examination and investigation so carefully taken history. I can help a large toe find out when history most important is a different sector. We have to remember that migrant had a really begins under 10 years. A tension headache issue with a dollar sent in Children population off course and more the whole insert abrupt onset of severe headache. Our 100 g headache may mean some intervention with allergies. Yeah, and if this is worse heading off life, maybe in document hammer it even so. Acute onset handy because never before must be taken very cities, so you can see of episodes. Plus the headache comes pupil three times a day for months. For migraine may have to before every sore in full one Denison had it could be a few days a week are all day long. New addition of episode or last headed nutrition is 5 to 15 minutes, but may last up to one. Migraine may last 123 R's, but sometime it go up to 2 to 3 days. Even tension headache me Last word. I'm off episode. So when had it Stars in line gold position are sleep early Morning it four stores. Rays interviewing pressure that mean intracranial Late morning on headache is usually from frontal. Sinusitis are other Sinus infection and later during day is a tension headache receiving evens any or are room is a feature off elastic In my, uh, any see a primary you had a big, big ah go really call up Headache. The quality of headache Help some clue in diagnosis like true being pulsating, hammering most family in my brain. Freezing her Take intention. Uh, taking our deportees. Headache is less for headache Location. So localized headaches, usually suggest a local like sinusitis with Parkinson video monitor. Let's let's have a look. My friends are by temporal Heavy is most likely in migraine. The drawer vehicles are temporal. Headache will be luster. Headaches. An occipital headache mean posterior cranium for south ality are busier. You getting factor poster activity, lack of sleep version, food, bright lights. My masterpiece. Our country could be heavy and both your is more related with the injecting pathologies. More headache in lying door. Our unit a diversion. It would be quite new. Course is interpreting your pressure relieving factor like rest and sleep in dark room. Most common in my pain, our sleep can relieve a tension headache. Similarly, in algesia medication or not. See, you can help the cluster headache relationship with other activity. School problem. Change of school can eat a tension headache We sent in, you know and sleep. Exercise diet can lead to headaches. Recent changes in growth are we in can be because, uh, pituitary few months Cleaning of ngoma are benign intracranial hypertension. Also serious symptom. Fewer neck pain, pallor, vomiting, diplopia, dizziness. All these point or stores infections are interfering with allergies. Psychosocial issues can lead to tension, headache and family skin is very, very important in my name. We are there, Children who will have my men will have a positive family. This is a good clue worth diagnosis. Do you feel ever give you a lab? So it is just, like, similar all the features. But we have to remember that headache. Maybe two types, like a person has my green may have heard it got those internal family. So sometimes Charlie present two different types of handing. So we need to know what is the more typical and more frequent type of headache so that you can make a diagnosis? Uh, the physical examination to be very total general opinions. Skin of them. Mission vital sign checking for BP growth perimeters, including head circumference in Children, their mission off eyes ent t temperament or a giant buying elevation off your vision of hired and complete your luggage lamination including fundoscopic and checking for signing off any manager irritation. After going through history of examination, we should make up our mind that word type of handy we are facing. And this step is very important for helping you to make a diagnosis. So After going to the history and then mission, you decide among yourself work sort of hard. If you're facing headaches can be. Only four nights were just on the cross roar that which way we have to go? Is it acute? Are new new onset headache then you causes are different if it is acute headache. But Regan many similar episode before then. Card. It could be different if it is groaning and nonprogressive headache means him have it going on for weeks and weeks. It made me different type of, and if it's grown e and progressive, it may mean a different group of head. So we have to categorize our patients into one of these to proceed. But better to order the diagonals. So cute. Handy systemic infection, Any fever, any infection, malaria, your protection in the morning. I can go ahead. Interviewing infections can cause headache. Remarkably had come out. Acute headache. Never before interpreting, Hambrick can call handy hypertension. I see person kind of have a handy sinusitis with darkness. Media kind of have a heavy, gentle abscess, mainly to hurt it. I problem and lead to headaches. Toxin like drugs and carbon monoxide poisoning can lead to headaches. Kill but required headaches well, headachy acute and quite severe. Are there many absolutely department. Most common is my green. That could be cluster headache are you would be a Caesar headache person. May have actually shouldn't be sore, but clinically complain only. What headache with the full, stricter feature in men. No little bit about prevalence on my being in first year after year. The migraine is almost equal in y guard, but at the age it wants is the prevalence of my brain become more and more common in females? Where the pee capital a thing. It is almost double them may, after sort of off migraine. Their clinical attacks on migraine migraine aura, which is God classical migraine, migraine without aura up your car, common migraine and their other condition, which have been group under my grandkids limbs. So do you associate with transit? Renew Logical, dysfunctional as that, like a Q per feeding my brain bazillion like green bean in Paris. Similar type. Oh, psychical vomiting Hemiplegic an awful mobility migraine person look like having a stroke, but actually it is basically my goodness traveling and global amnesia are examining Tartikoff. All of this would be a present patient off might be. Know the diagnosis Guardia International had, except you have made for periodic migraine we don't or why for more and sort of fairly lasting. Want to send it to ours, separated by symptom free interval. So it's very important in between the episodes or something. Three of Headache If it is really hard, it it is not my at least two off. These features are associative like unilateral I, by little being like one. Find out her. Both died of Head being up through with nature. Monitor severe pain aggravated by activity. Person has acute migraine episode. Routine activity has to be suspended. Otherwise headache can become more unbeatable. Associated symptoms are not. The other. Vomiting are photophobia phonophobia. At least one of these Lester had the headache, which can be mixed up with migraine, although it's much less common than my brain. But many features of similar but still, if you take care fully, you cannot discriminate. Let's know the Greek or or, you know, weeks or a month separated when terrible of years, the headache will be almost daily for appeared than it was going be a and May come back after a month on sex After 10, you're a fee. So while migraine is before 10 years migraines more common in females, this is more common in me. The families is classically negative in yes, headache. Offer begins during sleep occurs involves lasting 15 to 60 minutes and refused to six time. Each day usually starts behind and around the eyes and then become hammy. Continue and a lot of his Reeker only see inside of head in subsequent attack. So let's read. It will come on the right side or left side while migraine can Come on. Go sight. Artemis, do you need attack in case of cluster headaches, Person kind of space. Still, he will be very restless walking around on putting him in a dark room peacefully will not give him really So this all you can discriminate from my analogy in vomiting is not getting cluster headache scalp, maybe tender on animators. If the little hammock granule Arkan, Amit dysfunction could be dear. No much relief from common allergies IX so what Ripped own and oxygen inhalation can treat and acute day and recurrence can be prevented by prednisone. So there were bit of feature, which are similar, but many are quite different than migraine, and one can easily this cream. The tired group is chronic but nonprogressive addict. I mean, same headache for own going for months and weeks are together. Most common is tension. Headache. In actually supposed to America T A person has a head injury, which are significant that can lead to also having any headache, which may last for weeks and months, and it basically bone headache. So many people with minor headaches are in habit of taking too much being killer, like personal mole another and the day they don't take it. You got any bone headed giving her ticket. Also, when people are consuming like off the 18 and they did the know take your coffee, they got it. And similarly headache associated with all substance abuse It a couple questions. No Roman collector so far. Enjoying it is wrapping will not used for cluster headache prophylaxis. Which one verapamil So a calcium channel blocker? Yeah, there are many things being dry, but so far no prevention is you preferred for class frantic because once one attack spell of attacking over you don't know. Maybe next two years, you know? So why you take some medicine, which has its own side effects? Yeah, man, Uh, would you crossed headaches that come from I strain is tension. Headaches as well. Usually, you know, it is a commonly talked that maybe some animal perfection calling headache more subject time. The people who have headaches, the compass after I test it. And I don't know, so very, really effective at really called heavy. Very something. Like using a tablet, although time, you know. Yeah. Not so much. Not saying as much about you. Yeah. What? I mean, that person have suspicion that the eyesight is guarding her dignity. I'm getting it checked to clarify, and then it's like it started work. Sort of headache is to be getting more diagnostic. Approve it rather than guessing and treating you. Thank you. Yeah, Brian. And say much so next to the group of itches. But with the funding. Oh, one slighted meeting. Hope we can go. Good on it. Progressing room. Did you quit? No. Yeah. Excellent. Groaning. Progressive. Ready? Who? This headache on the very rear. But the other serious issue. So when the headache is there and day to day it is getting more and more severe insularity and more more addict symptom like now the ER. You know, early morning vomiting are handed during sleep, waking up getting city. So these are a few conditions, which can cause it like brain tumors. But an abscess being entertaining. Hypertension high. Go get numbness, which really acquired hydro can't miss it. And federal vascular malformations. Well, the clinical features, which are pointing towards interacting with allergy, which everyone need to know if you're dealing with Children. Outer darkness that had it in history. Headache. Awakening the child from sleep Are you more in handy? A bone waking up Headaches worsen in lying on post cough. Mitchell, a shin are defecate in whenever their version are lying on both year. The intervening pressure in cages and that really got a headache. Kinking pattern or severity of honey may be interfering with allergy and oxygen. Headache may have an interesting Do you need a feature indicating interning pathology it left and six years or snort. It changes developmental regression. Know this remember reduction is a red flag for intervening pathology and right what? I mean, those are not dealing with Children that return was running wrong. He stopped running and walking carefully. It really was walking, stops walking and starts crawling on. And can you are seeking start, start sitting alone. So that is the serious indicator off interacting. And if we consider that just your your mental regression not in direct ality You may be late intact and I've seen people diagonal Children very low because they know this is like a multiplication because many ready important physical sign abnormal group, too much fast growth. Are you putting 12 man headache duration in less than six months? Risk. You'd recent headache need to be explored. That's a family history of migraine when it jack person present something December like my green, but the new families were taking more. C's Unical future indicated in technicality hope this new medical condition like immune deficiency. Wow, Look at you congenital heart disease with the right to left because I do these all the site EMEA malignancy. Our office. We are pregnant. So even if malignancies declared cured, maybe after a couple of years, person may have a headache and actually it is a newly growing secondary. It can clinical future indicating in general allergy among physical examination have a normal neurological damage, like a sexy A weakness focal sign. Very cities diplopia of normal I movements that will it be more recognized? Hemorrhage. Perennial brooms. That new, continuous Inderal. All of these blanks for intervening time, Mr A Tad. So this is a group is not coming in. Any group connected disorder can be to have a metabolic disorder. And you had it. My folks. Yeah, I protect me. And finally you had a Dallas is good one. Long term dialysis taking a very great Do you have number one teacher or intra articular injection? They have a post procedure headache for days. And your LDL are trigeminal neuralgia here. Investigation. So you got the basic investigation? We'll do. But although person comes with a headache, he had the mind. Who got the scan done? Enough head. So let's see where scan is urgently indicated. So do you have urgent indication that we must do scan immediate. The first is worst headache of life or under club were personally never experience. Headache certainly ended up in emergency. That here very right. We had heard it. So that challenge should be taken on a dirt should be taken. See it because you often turn a little deal up to 5% In such cases. Certain own set of new See a headache Having increasing severity and frequency requirements are the morning headache. Frequent awakening. You had it occipital headache in peace being with straining, coughing, then normally radical signs. It used to be, you know, cranky Kadian growth rate. Well, my other regression are recently in behavior. All these are indication for it quick, but it's good. So I know you come to the management. So I go to just briefly only so posting a second headache. That means some underlying God who we have to raise It called What is government headache and wasn't really because that it will go No come next. On the probably headed there is an older link off. So that means bluster. Headache are might be so. Here the keeper is for logical. Trap E, which is to form one, is treating acute attack in the farmer about it, and one is proof elected. If the attacks are requirement, and then come the psychology sport for headache. Yeah, then being minimal techniques can also help. And here traffic and also help. So let's see quickly how we treat an acute attack. So generally you're for a barbiturate P r. A question of general family. How could be in acute attack eating a daddy of her attacks? Precedent dating factor to be identified like stress. Worse, really special foods. Rather king gives menstrual years, then less stinging. Dark, quiet room with a full glass apply to the forehead is helpful. Medication which can be helpful in acute attack of migraine, are at a sitter more and roof and lucky. Most of the Children with migraine can be beautiful district Really they need attack is to, you know, distressing that will be used. So I get down. Are you on Medicare? So this can help me. A barking an acute. Sometimes it is one working with every attack. Seeing those Children. They're three valuable medicine which can help to friend vomiting one is a local chlorpheniramine. One is metoclopramide and one is don't among all of the safest. Is prochlorperazine really known as stimulated? Why this drug is no more popular in our books and the teachers, because hopefully is not making money off. So they like people to be lowered. This is the best medicine to prevent vomiting from any interaction. It continual problem and it is very ready TV one thing they make us couple pennies. So this is safe drug we use in combination with some markers Done a barking acute attack out my then prophylaxis. So it is only indicated if they're more frequent. Attack like you are water tax for months, dosing frequency of her tags and significant disability despite adequate people. Aptitude test like somewhat kryptonian not helping stomach is not helping. Then we can go for prophylaxis, but it is very really required in Children. You can see maximally every couple of years we prescribed once some profile axes to Children, mostly with treatment, they can manage attack. They learn very well in adults, certainly prophylactically with the choir. So the commonly drug use for prophylaxis on three for a friend along. By that I mean and oh, not this by the 19 most commonly used any decisions. But overall, you know how much ability off all tree to prevent My name is very Some people get benefit for some people. So no, I'm trying. If it is too frequent to absolutely frequent far people 30 the and anxious all the preventive. Thank you anyway. Wonderful. Thank you very much. Because there's a QR code there. Um, you can use to It will take you through 12. Feedback is just up the webinar. I will post in the chat a link to the feedback as well. We really enjoy it. I mean, look at your feet back last time. It's really positive, um, and gave us some things to work on on disability. Even if you don't want a certificate, people olio just take a couple minutes. Fill that out for us. In the meantime, Did anyone else have any questions? I'm just having a look at the chat on my separate screen here. So if you have any questions, do post them now. Otherwise, I had a question of migraines in cluster headaches with Children that suffer from the quite frequently will they typically persist into adulthood? Or is it something that they quite often grow out off? No, they don't grow mostly you. If you're having migraine, you will have again and all this energy so run into the question like very much could be slide to be shared. Wasn't able to get some of the information. So one thing that we will be doing is uploading the video recording to both medal on YouTube within a day. I can also have a look at what you happy for this time. Your mom, if I can see if there's a way for me to share the slides as well. I was looking to do enough for you. People are benefited on. Sarah's off the question. Is there any way to treat migraines that are related to periods? Yeah, Misskelley, Just like many men Have any future dad? Certainly computer. Something we can prevent on. They might be a little hard morning balance. So we have learned how to manage that. And taking medication early is back. If there's vomiting, better to take for your parenting or Symmetrel. And if attacks are really distressing, the person can take so much other right, mostly physical and roof in our enough. Uh, on we know the question from Paris teen. I have until I currently I apologize. If I'm not, would you ever give naproxen instead of ibuprofen, all that you never really given? Teenagers know I preference simple ibuprofen and benefit more with more and more fancy drug. You're using this comfortably, getting more and more. And one thing I want to share that my mother did. Yeah, she got on the rocks. Seem in there killer. Oh, because she was my dad, I think somebody prescribing steer. I've and she got stomach for pressure. Oh, there a necessity to use NC medication. We got company. Promote lot of 100 physics. I feel you stay with persistent more and, you know, hoping that it is extensively you them died. Thank you. Uh, a man, if on is asking, can we share the two week rules GPS yet? So go for that. I didn't see if I could get up loaded for you on and asks there. Any headaches are more typical if the child was born prematurely. No particular related to the prematurity. Yeah. No, no special level for preachers. You have a particular type of headache. Okay, Thanks very much. Take care of everyone for your questions. If you do have any further questions, you can always posting on the Facebook group or even send them email toe pediatrics at mindedly dot com. As I said, I would make sure that the video of this goes into middle tonight and probably YouTube it nondetected day or so to upload that I'm look out for that. We only share on on social media. Thank you very much. Once again is actually pleasure. I definitely lost. So let me see if I like do job, you know? But it's very important.