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Course: Pediatric Nursing

Topic: Nursing Care of Child with

Neurological Disorders (IV) (Headache)

The Nurses International Community

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Module Goals

Learners will be able to:

Identify factors associated with headache in children
Identify common signs and symptoms
Identify risk factors associated with headache
Explain the role of the nurse in caring for children with headache and nursing interventions

Contact info: info@nursesinternational.org

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Headache

Acute Headache

Pain in the head involving blood vessels, meninges and bony and soft-tissue components of the head.

Also defined as diffuse pain in various parts of the head not confined to the area of distribution of a nerve.

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Headache

Chronic or Recurrent Headache

Pain in the head occurring on a chronic basis
Causes:

Vascular (migraines)
Muscle contraction (tension headaches) and
Organic cause

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Types of Headache

Migraine
Tension
Headache from infection
Medication overuse headache (analgesic rebound headache)
Headaches after a head injury
Headaches associated with dental problems (such as jawbone joint problems)

Nationwide Children’s , 2021

Contact info: info@nursesinternational.org

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Causes

Common Causes

Systemic illness with fever
Tension Headaches
Cluster Headaches (older children)
Localised ENT problems
Migraine +/-Aura

Uncommon causes

Raised intracranial pressure (ICP) from:

Tumors, bleeds
Hydrocephalus
Hypertension

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Causes

Infection:

Brain abscess
Dental infection
Encephalitis
Meningitis
Sinusitis (chronic)

Trauma

Neck injury
Post-concussion syndrome
Subdural hematoma

Government of Canada, 2013

Toxic Effects

Carbon monoxide
Heavy metal poisoning (for example, lead)
Non Medicinal agents
Excess intake of vitamins

Psychogenic

Conversion
Depression
Factitious

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Causes

Other Causes

Food allergy or sensitivity
Refractive error
Ocular muscle imbalance

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Critical Thinking Question

What are the most common causes of headache in children?

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History

Onset:

When headache began
Conditions associated with initial headache (for example, trauma, drug ingestion)
Aura: visual, auditory

Location
Radiation

Where headache starts and radiates to
Occipital radiation: neck problems, occipital neuralgia, basilar migraine
Facial radiation: sinus, dental or temporomandibular joint (TMJ)

Government of Canada, 2013

Contact info: info@nursesinternational.org

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History Assessment

Quality

Sharp, dull or tight
Throbbing or pounding (characteristic of vascular headaches)

Severity

Use a rating scale for pain
Does it interfere with child's day-to-day activities?

Timing

Constant or intermittent
Frequency
Whether frequency or severity increase over time

Government of Canada, 2013

Contact info: info@nursesinternational.org

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History (continued)

Associated Symptoms (Functional Inquiry)

Nausea and vomiting with or without abdominal pain (typical of migraine)
Photophobia, facial pain, fever
Transient neurologic signs
Acute confusion, hemiplegia, ophthalmoplegia, syncope, vertigo, paresthesias, phonophobia
Depression
Anorexia, declining school performance, insomnia, weight loss
Past medical history
Family history of headaches

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Physical Findings

Usually minimal finding with headaches

Blood pressure usually normal
Temperature may be elevated with infectious process

HEENT (Head, Eyes, Ears, Nose and Throat)

Facial grimacing
Nuchal rigidity
Funduscopic examination results are often normal
Spasm or tenderness of neck muscle
Deficits of cranial nerves
Purulent rhinorrhea
Halitosis, dental abscesses

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Physical Findings

Neurologic Examination

Level of consciousness
Mental status: general demeanor, confusion, depression, stress
Cutaneous lesions (café au lait spots)
Focal abnormalities (for example, tics, limb paresis)
Sensory deficits
Abnormal deep tendon reflexes

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Physical Findings

Clinical Characteristics of Common Headaches

Headaches Related to Increased Intracranial Pressure

Increase rapidly in frequency and severity
Worst upon awakening in the morning, diminishes during the day
Wakes child from sleep
Aggravated by coughing or Valsalva maneuver
May be relieved by vomiting
Associated symptoms: focal neurologic finding

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Critical Thinking Question

What are the characteristics of headaches related to Increased Intracranial Pressure?

Wakes child from sleep
Aggravated by coughing or Valsalva maneuver
May be relieved by vomiting
Increase rapidly in frequency and severity

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Diagnostic Test

Most headaches can be diagnosed from

The history and physical examination

Neuroimaging recommended if:

Worsening headache
Changes in types of headaches
Changes in neurologic function including changes in school performance
Onset of severe headaches

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Treatment

Goals of treatment depend on the cause of the headache.

Acute

Rule out serious organic pathology
Relieve pain

Recurrent or Chronic

Relieve pain
Prevent recurrence
Avoid disruption of normal life activities, such as attending school

Appropriate Consultation

Headaches are chronic and unresponsive to simple analgesia

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Nonpharmacological Intervention

Supportive reassurance and education:

Advise parents that headaches in children are common
Explain underlying pathophysiology
Counsel about avoiding factors that trigger headaches
Identify stressors and advise on how to deal with them
Counsel about use of medications (dose, frequency, side effects)

Relaxation and imagery therapy:

Breathing exercises
Visual imagery exercises
Hypnotherapy
Relaxation tapes

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Pharmacological Interventions

For tension headaches and mild migraines, analgesics are useful:

Acetaminophen 10-15 mg/kg per dose (analgesic of choice), q4h prn
Children > 6 years old may be given 325 mg, and
children > 12 years old may be given 325-650 mg PO q4h prn

Do not use acetylsalicylic acid (ASA), as it is associated with Reye's syndrome

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Pharmacological Interventions

Nonsteroidal anti-inflammatory drugs (NSAIDs):

Ibuprofen (Motrin), 5-10 mg/kg per dose, PO q6-8h prn, to maximum of 40 mg/kg/day

For migraines:

Avoid precipitants (triggers)
Simple analgesic (acetaminophen, ibuprofen) may be given at first sign of aura or headache
Avoid narcotics

Government of Canada, 2013

Contact info: info@nursesinternational.org

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Prevention

Get enough sleep and follow a routine
Serve meals at regular times
Do not let a child skip meals
Should drink plenty of liquids, especially water
Sports drinks may also be given
Make sure a child gets regular exercise or active play
Provide support for stress and emotional upset
Encourage child to talk openly with parents/caretakers about concerns

Nationwide Children’s, 2021

Contact info: info@nursesinternational.org

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Nurses Role/Interventions

History taking

Onset, location,quality, radiation, severity, timing
Associated symptoms

Physical examination

Head, Eyes, Ears, Nose and Throat (HEENT)

Neurological Examination
Supportive reassurance
Encourage relaxation and imagery therapy
Administer medication as prescribed
Education on management techniques and preventive measures

Contact info: info@nursesinternational.org

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What Would the Nurse Do?

A nurse is teaching a mother about ways to prevent their child’s headache.

What instructions should the nurse should provide? (Select all that apply)

Make a child gets enough sleep and follows a routine
Serve meals at regular times
Let a child skips meals
Encourage to drink plenty of water
Encourage the child to ventilate the feelings

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Red Flags

Headaches on waking from sleep
Vomiting in the morning
Persistent visual disturbance
Sudden onset of headache (like being hit by a ball)
Motor weakness
Poor balance
Reduced LOC

Government of Western Australia Child and Adolescent Health Service, 2022

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur
Health customs: In some cultures family members play a large role in health care decision-making
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations

AHRQ, 2020

Contact info: info@nursesinternational.org

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

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References

Government of Canada. (2012). Clinical Practice Guidelines for for Nurses in Primary Care- Pediatric and Adolescents Care. https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/health-care-services/nursing/clinical-practice-guidelines-nurses-primary-care/pediatric-adolescent-care.html

Government of Western Australia Child and Adolescent Health Service. (2022 July). Headache.https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Headache

Hockenberry, M. J. & Wilson, D. (2007). WONG’S Nursing Care of Infants and Children. 8th edi. Mosby

Nationwide Children’s. (2021). Headache in Children. https://www.nationwidechildrens.org/conditions/headaches-in-children

Contact info: info@nursesinternational.org

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