Pediatric Migraine. over. X10886 ( 2/10) Front Pediatric Neurology Approved for distribution by Spectrum Health Patient Education Council
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1 Pediatric Migraine What is a migraine? More than 10 million children between the ages of 5 and 17 have chronic headaches. A migraine is a type of chronic headache. Patients with migraines may also have throbbing pain, an upset stomach and vomiting. Patients may also have changes in vision such as blurring or seeing flashing lights, as well as being sensitive to light or sound. Migraines may be caused by a combination of changes in the blood vessels, brain chemicals and nerves. Migraines may keep you from normal activities like work or school. What triggers, or causes, a migraine? Migraine triggers include environmental factors (dust, plants, smells, lights) or diet (what you eat). t every patient can name a certain trigger for their migraine. Below is a list of some common triggers: Cheese Weather changes Dairy Stress Citrus fruit (lemons, oranges, grapefruit) Exertion (doing to much) Chocolate Too much or not enough sleep Caffeine (soda, pop, coffee, tea) Menstruation (having your period) Sourdough bread and pizza Monosodium Glutamate Hotdogs, salami, bologna Skipping meals What can I do to prevent or lessen a migraine? The following are things that can prevent or lessen a migraine: Regular exercise Sleep Watching what you eat Identifying and staying away from known triggers Medication and non-medication methods such as physical therapy, counseling, and biofeedback What medications are there to help treat a migraine? Medications are not always helpful. There are two types of medications that are used to manage migraines: Preventative medications - medications that are taken every day to keep a migraine from starting over X10886 ( 2/10) Front Pediatric Neurology Approved for distribution by Spectrum Health Patient Education Council
2 Abortive medications - medications that are used to stop a migraine after it has started Your doctor or nurse practitioner will tell you which preventative and abortive agents are best for you. What information does my doctor need to know about my migraines? Your doctor or nurse practitioner will ask you to keep a headache diary. This diary will help them know what type of headaches you may be having. It can also help you spot triggers that cause your migraines, and show the number of times you have a migraine. If you did not get a diary during your visit, please ask for one. If you would like more information about headaches we recommend that you visit our website: choose the Health Information A-Z tab. This handout does not take the place of a discussion with your doctor. Discuss any questions or concerns you may have with your doctor. X10886 ( 2/10) Back Pediatric Neurology Approved for distribution by Spectrum Health Patient Education Council
3 Confidentiality of this medical record shall be maintained except when use or disclosure X10879 (9/13) *X10879* DO NOT MARK BELOW THIS LINE BARCODE ZONE DO NOT MARK BELOW THIS LINE Month Record HEADACHE - PEDIATRIC Patient name Date of birth Patient Name SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY PAIN SEVERITY Faces Code 0-10 (0 = none, 10 = severe) S = Missed school A = Missed activity Young Women: Circle each day of your period. Instructions: Fill out calendar for the current month. Record headaches on appropriate day with severity, whether you missed school or an activity, and any trigger by using the code number. If you used medicine to help stop the headache, write the name and whether this helped. Give the calendar to your healthcare provider at your next office visit. X10879 (9/13) DOB MRN Physician FIN POSSIBLE TRIGGERS 1. Chocolate 8. Nuts 2. Cheese 9. Onions 3. Citrus fruit 10. Salty foods 4. Processed meat 11. Caffeine 5. MSG 12. Stress 6. NutraSweet 13. Fatigue 7. Skipped meal 14. Missed medicine
4 Patient Name DOB Questionnaire Headache - Initial, PEDIATRIC, neurology clinic MRN Physician FIN How long have you had headaches? How many types of headaches do you have? Complete the chart below for each kind of headache you have. Ask for another questionnaire/chart for additional kinds of headaches. Identify the severity or type of the headache, then under that type describe. Confidentiality of this medical record shall be maintained except when use or disclosure HEADACHE examples of TYPE 1 TYPE 2 Descriptors (Describe) (Describe) Location Frontal, behind eyes, all over, etc. Character Throbbing, stabbing, constant pressure, etc. Other features Loss of appetite, nausea, vomiting, sensitivity to light/sound Frequency Daily, weekly, 2 times/month, etc. Length Seconds, 30 minutes, hours, days, etc. Instigators Ice cream, hot dogs, stress, loss of sleep, etc. Warning signs Visual changes, flashing lights, nausea, etc. Relievers Motrin, Tylenol, nothing, aspirin, etc. Medications (See below) taken PREVIOUS/CURRENT MEDICATIONS DOSE taken HOW HELPED if helped, Examples (acetaminophen, ibuprofen etc.) often how much Allergies Have you: Been hospitalized for headache Taken Vitamins A, E or other supplements Gained weight Been hospitalized for other reasons Been injured in an accident Had rash Been confused, disoriented Been treated for acne Had fever with headache If any of the above are checked, provide details do not mark below this line barcode zone do not mark below this line over X11009 (1/09) Front *X11009*
5 Birth and development history Family medical history Surgeries Have you had any of the following tests? TEST YES/NO IF YES, WHEN IF YES, WHERE MRI of Brain CT of Brain Skull Films Other Do you or a family member experience: Carsickness Migraines Chronic illness Stroke Lupus/arthritis Heart disease Need for a pacemaker Substance abuse Depression Suicidal thoughts How many hours do you sleep each night? Is it restful? What activities are you involved in outside of school? Do you have an after school or weekend job? Do you exercise? Do you drink water daily? If yes, how much? Do you drink coffee/cola? If yes, how much? Do you eat breakfast? If yes, what do you normally eat for breakfast? Because of your headaches, have you or have you been? Seen in the Emergency Department Missed school If yes, how much/often? Seen by my doctor Missed activities If yes, which ones? Seen a physical therapist Seen a counselor or psychologist What stresses have you had? School Grades Friends Boy/Girl-friend Classmates Parents Sisters/Brothers Loss of pet/relative/friend Recent move Peer pressure Trouble with drugs, alcohol, law enforcement Other What things are you most concerned about? Being sure nothing is seriously wrong with me/my child Returning to school Getting completely rid of my headaches Getting my headaches under better control Changing my health habits Reducing my medication use Sleeping better Date Time Patient signature Confidentiality of this medical record shall be maintained except when use or disclosure If not patient, name of person completing questionnaire Relationship to patient Date Time Physician s signature X11009 (1/09) Back
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