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Dear Julia
I thought I would add my comments. Great content in your news letter.
Primary headache in children is common and disabling. One would expect at least one child in a class room of 30 to have a headache disorder in a primary school.
Headache, by which I mean migraine as such is a genetic disorder. You will always get a history of headache or headache tendency in the parent.
In children, making a diagnosis, giving a label often goes a long way towards therapy. Lifestyle, triggers and psychosocial factors play a big role in the management.
Medication for acute pain if used regularly – can itself lead to headaches.
In large series, the incidence of significant intracranial lesion including tumor in the absence of other neurological signs in a child with headache is less than 0.08%
Neuroimaging for a headache problem in a paediatric population is best done in a centre where expertise exists to interpret paediatric scans – A number of children have normal variants of anatomy which can be misinterpreted raising anxiety for all.
School attendence (or lack of) is a good predictor of problem headaches and these children will need a multidisciplinary approach and possibly referral to paediatrician/headache specialist.
Referrals to the Children’s Headache Clinic at Great Ormond Street is via the consultant Paediatrician.
(http://www.gosh.nhs.uk/gosh/clinicalservices/Neurology/InformationforHealthProfessionals)
Referral Criteria:
1. Child 16 years or below
2. There is a question about the type of headaches
3. Child has intractable headache refractory to 2 or more prophylactics
4. Rare primary headaches including ophthalmoplegic migraine, cluster headcahe, SUNCT, SUNA etc
Resources;
1. http://www.migraine.org.uk (there are links to different age groups)
2. http://www.migrainetrust.org/information-for-sufferers
3. http://www.bash.org.uk/ (guidelines for primary care physicians)
Children’s Headache Clinic
Dr Prab Prabhakar
Consultant Paediatric Neurologist
Great Ormond Street Hospital
London WC1N 3JH