Combined GP and ED versions for August 2011

Well the BMJ produces 2 journals in one in August so why can’t I?  All the topics featured this month are relevant for both GPs and ED doctors – for once – so you have a joint newsletter.  I have covered headache this month, Vitamin D (by popular request) and we have started the “Feeding” series requested by my ED senior colleagues.  It seems appropriate to have covered breastfeeding first.  Do leave comments below.

One thought on “Combined GP and ED versions for August 2011

  1. 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.

    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

    1. (there are links to different age groups)
    3. (guidelines for primary care physicians)

    Children’s Headache Clinic
    Dr Prab Prabhakar
    Consultant Paediatric Neurologist
    Great Ormond Street Hospital
    London WC1N 3JH

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