RESUMEN
PURPOSE: To examine symptoms indicating central nervous system (CNS) autonomic dysfunction in pediatric patients with migraine and tension-type headache. METHODS: A retrospective chart review assessed six symptoms (i.e. constipation, insomnia, dizziness, blurry vision, abnormal blood pressure, and cold and clammy palms and soles) indicating central nervous system (CNS) autonomic dysfunction in 231 patients, ages 5-18 years, diagnosed with migraine, tension-type headache (TTH), or Idiopathic Scoliosis (IS). RESULTS: Higher frequencies of "insomnia," "dizziness," and "cold and clammy palms and soles" were found for both migraine and TTH patients compared to the IS control group (P < 0.001). Frequencies of all six symptoms were greater in TTH than migraine patients with "cold and clammy palms and soles" reaching significance (P < 0.001). CONCLUSIONS: The need for prospective research investigating autonomic dysfunction in pediatric headache patients is discussed.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Sistema Nervioso Autónomo/fisiopatología , Trastornos Migrañosos/fisiopatología , Cefalea de Tipo Tensional/fisiopatología , Adolescente , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Niño , Preescolar , Mareo/etiología , Femenino , Humanos , Masculino , Trastornos Migrañosos/diagnóstico , Estudios Retrospectivos , Escoliosis/fisiopatología , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Encuestas y Cuestionarios , Enfermedades de las Glándulas Sudoríparas/complicaciones , Sudoración , Cefalea de Tipo Tensional/diagnósticoRESUMEN
BACKGROUND: Headache is the most common type of pain reported in the pediatric population, and chronic headache is an increasingly prevalent and debilitating pain condition in children and adolescents. With large numbers of students experiencing acute headaches and more students with chronic headache reentering typical school settings, greater availability of tailored evidence-based practice guidelines for school nurses is imperative. METHODS: A 2-armed study was developed to assess the need for and evaluate the use and favorability of a headache-driven school nurse guide. Students and their parents were first surveyed on their school nurse's headache knowledge and management skills. School nurses were also interviewed on their desire for a headache educational tool. This feedback aided in developing a headache resource guide. Next, the guide was distributed to school nurses who provided feedback after a 3-month trial. RESULTS: Results indicate that "Headache Tools to Stay in School" is a useful resource in facilitating communication among health care providers, students, families, and school personnel on how to best meet the complex needs of students with headaches. CONCLUSIONS: Given the guide's favorability, we encourage school nurses to demand the creation of additional evidence-based resources. Continued dissemination of this guide may improve students' headache management under the informed care of school nurses, and may encourage the development of more evidence-based guides across various medical conditions.
Asunto(s)
Cefalea/prevención & control , Cefalea/terapia , Educación del Paciente como Asunto/organización & administración , Servicios de Salud Escolar/organización & administración , Servicios de Enfermería Escolar/organización & administración , Adolescente , Niño , Conducta Cooperativa , Práctica Clínica Basada en la Evidencia , Familia , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Both cannabis and traumatic brain injury (TBI) pose risks on the developing brain, including a potential increased vulnerability for developing psychosis. Recent reports detail an upward trend in both adolescent cannabis use and the concentration of THC, the most potent psychoactive component in cannabis. Similarly, it is estimated that 1.7 million Americans incur a TBI each year. Previously trivialized as a minor nuisance, attitudes towards TBIs are changing as researchers and the public recognize TBIs' possible long-lasting sequelae. CASE REPORT: Two cases are presented of adolescent patients with histories of TBI and self-reported heavy, recreational cannabis use who developed symptoms of psychosis. DISCUSSION: Similar neuronal signaling pathways involved in cannabis ingestion and TBI recovery, specifically CB1 receptors of the endocannabinoid system, as well as the allostatic load model provide context for the two presented cases. Given the cases and theories presented, we believe that cannabis use may act as a neurological stressor and risk factor for psychosis outweighing its possible benefits as a therapeutic solution for pain in late adolescent and young adult populations. SIGNIFICANCE: The presented cases provide further support for the compounded risk of developing psychosis following TBI and cannabis use.
Asunto(s)
Lesiones Encefálicas/complicaciones , Fumar Marihuana/efectos adversos , Psicosis Inducidas por Sustancias/etiología , Trastornos Psicóticos/etiología , Adolescente , Humanos , Masculino , Abuso de Marihuana/complicaciones , Adulto JovenRESUMEN
Despite limited evidence from the literature surrounding safety or efficacy, butalbital-containing medicines (BCMs) have maintained their rank as "go-to" prescribed migraine and headache relief drugs in the United States, despite bans on these barbiturates in Germany and other European countries. Providers at the Pediatric Headache Program at Boston Children's Hospital recommend that clinicians prescribe triptan-based medications instead of BCMs, given the known negative side effects of BCMs on the general population, and the uncertain longitudinal trajectory of BCMs on developing brains.