peds exam one
SIDS precautions - Back to sleep. …
Keep the crib as bare as possible. …
Don't overheat your baby. …
Have your baby sleep in in your room. …
Breast-feed your baby, if possible. …
Don't use baby monitors and other commercial devices that claim to reduce the risk of SIDS . …
Offer a pacifier. …
Immunize your baby
What percentile for BMI would classify a child or adolescent as obese? - <95
At what percentile is a child at risk for developing obesity - <85
family assessment - family roles
knowledge
support systems
siblings
Infant Hospitalization - separation anxiety
fear of injury and pain (treatment room)
loss of routine
preschool age hospitalization - separation anxiety
fear of injury and pain
loss of routine
guilt and shame
school age hospitalization - seperation
fear of injury
loss of routine and friends
Adolescent hospitalization - -separation ambivalence
-fear of disfigurement/ pain
-loss of control autonomy
helping children cope - -patient family rooming in
-child life program
-therapeutic play
child's play - playrooms- safe space
teaching through play
therapeutic play
emotional outlet play
unstructured play
child stressors from life threatening illness - anxiety/fear of dying
invasive procedures/unfamiliar equipment
unfamiliar environment
limits on family presence
family emotional response - •Shock and disbelief
•Anger and guilt
•Deprivation/loss of familiar role
•Anticipatory waiting
•Readjustment or mourning
•Irritability
•Crying/Withdrawal
•Hostility toward staff/Emotional outbursts
•Fear
parental stressor - •Poor communication
•Overstimulation in the unfamiliar environment
•Altered parental role
•Interruption of parent-child relationship
•Child's behavior or emotion
•Child's appearance
•Unexpected
•Little time to prepare
•Distance from home to hospital
parental needs - •Information
•Proximity to Child
•Retaining parental role
•Participating in child's care
•Confidence in treatment & caregivers
•Psychologic support
Family Presence During Resuscitation - standard of care
myths about family presence
family centered care
staff liaison
Siblings of ill children - •Experience considerable stress related to sibling's illness
•Require care at a developmentally appropriate level
•Describe what the sibling will see, and how to interact with ill child
•In the event of death:
•Need reassurance they did not cause the death, that death is not a punishment for their wrongdoing
•Prepare siblings who want to say goodbye for what to expect
Children and the Dying Process - •Infant: senses caregiver emotions and altered routines
•Toddler: can't tell death from separation
•Preschooler: death is temporary, magical thinking about causation
•School-Age Child: death is permanent; may assign guilt or blame
•Adolescent: understands death, but sense of invincibility can conflict
with acceptance of death
Nurses' Coping with Caring for a Dying Child emotions - •Helplessness
•Feeling like they failed the child
•Sadness
•Grief
•Compassion fatigue
•May alternate between dealing with their grief and suppressing it
Nurses' Coping with Caring for a Dying Child managing - •Extra consideration is required for the nurse
•Mentorship with hospice nurse for ELC
•Debriefing sessions: Nurses should feel free to express their sorrow and grief
family centered care - Caregivers should partner with parents to care for their child
Talk with parents about what is happening clinically and explain rationales
Encourage questions, and writing them down if clinician is not present
Caregivers should respect parents' knowledge of their children
Parents know their children far better than we can; have learned to read cues
Especially true of children with pervasive developmental delay (PDD)
Caregivers should be aware of family structure and values
May be non-traditional situation (grandparents, etc.); don't assume someone is a parent!
Different spiritual and ethnic backgrounds
active listening - Attentiveness: Maintain eye contact and minimize distractions
Clarification by reflection: ask 'why?' and 'what else can we do?'
Empathy: Acknowledge and validate feelings
Impartiality: be open-minded
managing conflict with families - Be aware of oblique verbal and non-verbal cues. Many families may be unhappy or upset but restrain themselves until they 'explode' when they reach a breaking point
First, try to understand the parents' perspective before anything else; what are their concerns? Many people are instinctively defensive but this may aggravate the situation
Use active listening and therapeutic communication skills to create a resolution
Respecting culture - Family decision-making practices
Child-rearing practices
Family structure & supports
Communication practices
Culture-specific health & illness practices
Not sure? Don't assume -> ASK
assessing the family - How much can the child communicate and understand at their developmental level?
What is the family's health literacy level? Education and language barriers?
Use professional interpreters; avoid the temptation of using family and bilingual children!
Family stressors, strengths, and resiliency
Family Stressors - All families experience stressors
Stressors
Routine
Nonroutine
Varies based on individual family's situation
Families respond to stressors
Interactions may change as a result
Nursing intervention can reduce the impact of a stressor on the entire family
family strengths - Communication skills
Shared family values and beliefs
Intrafamily support
Self-care abilities
Problem-solving skills
Community linkages
resilient families characteristics - Balancing illness with other family needs
Forming collaborative relationships with providers
Communication skills
Flexibility and commitment
Positive meaning to the situation
Coping and problem solving
parents and illness information - Parents and/or primary caregivers know their children far better than you - they have generally known them their whole lives and know how to read their cues.
pediatric history CIAMPEDS - Chief complaint
Immunizations
Allergies
Medications
Past medical/surgical history
Events surrounding the illness/injury
Diet and Diapers
Symptoms of the illness/injury
Pediatric Assessment Triangle (PAT) - Appearance, work of breathing and circulation to the skin.
Approaching a child for assessment -
- Talk to the child and parents first
- Parents not able to engage as well if distracted by an upset child!
- Order the systematic physical exam based on child age and state
- Asleep vs. awake
- Happy vs. upset
- Involve the parents!
Age appropriate education -
- Infant to 1 year
- Relatively easy to engage with, employ distraction
- Toddlers and Preschoolers
- Approach slowly
- Involve parents extensively
- School-age children
- Build relationship through simple questions, nonthreatening approach
- Adolescents
- Interact frankly and without condescension; treat as mature
respiratory pointers - Always expose the trunk of younger children, not only for better auscultation, but to visualize their work of breathing
Increased WOB looks different with kids than adults
Respirtatory assessment-
- What size is your stethoscope?
- Adult (general medical/surgical care)
- Pediatric (pediatric care)
- Infant (newborn nursery/NICU)
cardiovascular pointers -
- Children have better circulatory compensation than adults!
- Tachycardia is a possible early sign of problems
- Perfusion (delayed capillary refill) another early sign
- Blood Pressure is usually the last vital sign to become abnormal
genitourinary pointers -
- Often deferred exam by Nursing, especially as children get older, unless specifically warranted.
- Adolescents usually reluctant to be examined by opposite sex clinician.
- Try to have a second clinician present for GU exams in adolescents, especially pelvic exams ("chaperone")
HEENT pointers -
- Anterior fontanelle in infants (the "pediatric handshake")
- Dysmorphic facies characteristic of many syndromes such as Trisomy 21
integumentary pointers -
- Don't confuse "Mongolian spots" with ecchymosis in many minority children
- Ecchymosis and other traumatic changes are common on children's extremities: head, arms, and legs.
- Presence of these on the chest/back/abdomen should prompt further exploration of historical explanation
- Petechiae are of particular concern if present below the nipple line.
- Red 'freckling' rash characterized by not blanching when pressed on exam
Measurement I: Anthropomorphic measures -
- Growth charting
- Weight (kg)
- Height (cm)
- BMI = weight (kg)/ height (m^2)
- Head circumference (birth-36 months)
definition of pain - Pain is whatever the person experiencing pain says it is, existing whenever the person says it does.
Infants and children are often unable to communicate the presence, location, and type of pain.
gate-control theory - Gate control theory refers to a gating mechanism in the spinal cord that facilitates or inhibits pain transmission.
Stimulation of the larger afferent nerves can dull the pain.
Cognitive processes have an impact on pain transmission
acute pain - -Sudden onset and continuing for a limited period; experienced during and after procedures, postoperatively, from fractures, and from other bodily insults or injuries
chronic pain - -Unpredictable time limit, unlikely to resolve quickly, affecting child's ability to live a normal life; experienced in conditions such as juvenile idiopathic arthritis, sickle cell disease, and cancer
Obstacles to pain management myths - -Fear of respiratory depression
-Fear of addiction
obstacles to pain management -
- Deficient knowledge
- Inaccuracy of assessment
- Lack of awareness of pain management interventions
- Personal attitudes and beliefs
influences on pain assessment -
- Developmental level and emotional status
- Culture and ethnicity
- Previous experience with pain
- Type and duration of pain
- Personality type
- Parental response to child's pain
- Gender
- Genetic variations
Neonate and infant developmental level assessment -
- Rapid changes in behavioral state
- Distinctive motor movements associated with pain
toddler developmental level assessment -
- Generalized restlessness
- Guarding of the painful site
- Excessive crying
preschool developmental level assessment -
- Cry and struggle
- May deny pain
school-age children's developmental level assessment -
- Stiff body posture
- Withdrawn
Adolescent Developmental level and assessment - can describe quantity and location of pain
Pain assessment tools -
■Adolescent and Pediatric Pain Tool (APPT)
■CRIES Pain Scale
■COMFORT Scale
■Face, Legs, Activity, Cry, Consolability (FLACC)
■FACES Pain Rating Scale
■Numeric Rating Scale (NRS) (0-10)
■The Oucher Scale
■Poker Chip Tool
■Visual Analog Scale (VAS)
FLACC pain scale -
F: Faces.
L: Legs.
A: Activity.
C: Cry
C: Consolability
Wong-Baker FACES scale - a scale with drawings or pictures that clinicians use to assess pain in the cognitively impaired client.
Non-pharm interventions for pain - distraction
regulated breathing
guided imagery
topical heating/ cooling
touching massaging
non-opioid analgesics - acetaminophen
ibuprofen
ketorolac
opioids - -Hydrocodone, oxycodone (PO) - not codeine
Morphine, fentanyl*, hydromorphone (IV)
procedural sedation - -Propofol
-Midazolam
-Ketamine
-Nitrous oxide
Administering Analgesics to Children -
■Preferred routes are intravenous (IV) or oral.
■Intranasal fentanyl or midazolam is a good alternative route.
■Infants and children receiving IV and epidural opioids should be monitored by pulse oximetry.
■If respiratory depression occurs with opioid use, naloxone hydrochloride should be used for reversal when oxygen and stimulation of the child are ineffective.
Health Promotion - •Activities that increase well-being and enhance wellness and health
Health Maintenance - •Activities that preserve an individual's present state of health and prevent disease or injury occurrence; focuses on known risks
Primary prevention: - activities decreasing opportunities for illness or injury
secondary prevention - early identification & treatment to limit severity of a condition
tertiary prevention - reduction in consequences with aim of full restoration
nurses role of health supervision - •Update health history
•Reconcile medication lists
•Health screenings
•Developmental assessment
•Anticipatory guidance
•Identifying unmet health needs
questions to ask yourself during assessment - •Do infant and parent have close physical contact, eye contact, and vocalization during visit?
•Does the baby respond to eye contact, movement, and vocalizations by the nurse?
•Do parents appear relaxed or stressed?
•Does infant behave as expected for age and situation?
•Is parent able to effectively handle infant being seen as well as any other siblings present?
Nutrition for infant and toddlers - •Infant will triple birth weight by 1 year of age
•Determine formula or breast milk
•Transition from bottle or breast to solid foods
•Eating patterns
•Toddlers often eat small meals
•Guidance about food choices
•Eating habits now lay foundation for healthy eating in the future
Nutrition for school age children and adolescents - •Goal: Independence and healthy food choices
•Have strong likes and dislikes
•Prepare own snacks
•Access to vending machines
•Assess growth, hair and nails, food habits
oral care for infants and toddlers - •Inspect infant's mouth (thrush)
•Usually has 2 teeth by 6 months
•Wipe gums with soft moist gauze daily
•Child should begin seeing dentist at 1 year of age
•Develop brushing, flossing skills, and habits
•By 2 years of age, child has full set of 20 primary teeth
oral care for school age and adolescents - •Average age of first tooth loss: 6 years
•Eruption of permanent teeth
•Dental visits every 6 months
•Tooth brushing
•Braces/other hardware
infants and toddlers sleep - •Rapid transition to sleeping 10-12 hours at night with 1-2 naps during the day
school aged sleep - •Sleep 8-12 hours at night; sleep hygiene practice is important
adolescents and sleep - •Need 9 hours of sleep, get 6 hours average; internal clock change
injury and toddler injury prevention - •Discuss how parents can maintain a safe environment
•Car seats
•Choking hazards
•Falls
•Drownings
•Gun safety
•Home environment (meds, sockets, etc.)
•Homes infant visits
school aged children and adolescents - •More independence and activities lead to injury
•Gun safety
•Protective gear (helmets, pads)
•Burns
•High risk behaviors
infant and toddler disease screening prevention - •Immunizations
•Screening for various diseases, such as:
•Anemia
•Lead poisoning
•Metabolic disorders
•Immune system is maturing
•Screening for vision, hearing problems
•Importance of not being exposed to cigarette smoke
infants and mental health - •Temperament
•Stressors and how infant manages stress
•Signs of abuse, neglect
toddlers and mental health - •Observe interactions between parent and child
•New accomplishments help foster positive self-image and mental health
school age children and mental health - •Self-esteem: feelings of self-worth and value
•Self-concept: self-evaluation in specific areas such as appearance
•Positive v. negative
adolescent disease treatment and screening - Screening tests during adolescence:
•Scoliosis
•Anemia
•Sexually transmitted infections
•Vision and hearing
•Blood pressure
•Pap smear, breast exam
•Testicular exam
things to assess for among adolesents (5 topics) - smoking/vaping
depression
stress
alcohol/ substance use
immunization status
prevention of skin cancer - sunscreen use
limiting exposure
tanning beds
mental health links in adolescence - •Gaining independence
•Forming close relationships
•Becoming confident in accomplishments
•Setting goals for the future
adolescent assessment (what to ask) - •Ask what the teen is proud of
•Ask what the teen is disappointed in
•Ask about body image
•Ask about sexual activity
•Ask directly if they have had intercourse
•Focus on birth control, prevention of sexually transmitted diseases (STDs)
Macronutrients - carbohydrates, proteins, and fats
Micronutrients - vitamins and minerals
Infant Nutrition - •Breastfeeding up to 6 months preferred
•Transition to pureed foods around 6 months
•Introduce "finger foods" once infant has established ability to eat puree
•Move to "sippy cup" by 12 months, no bottles
infant supplementation - •Infants may receive supplementation: fluoride, iron, vitamin D
toddler nutrition - •High metabolic demands of infancy slow down
Intake patterns
•Healthy meals and snacks
•Self-feeding preference
•Let toddler make choices
Physiologic anorexia in toddler - this is common and occurs round 18 months due to decreased metabolic demands
school aged nutrition - •May be resistant to new food items
•Encourage appropriate food choices
•School involvement in nutrition
•Dental care
•Tooth hygiene
•Fluoride intake
•Loss of deciduous teeth
•Eruption of permanent teeth
adolescent nutrition - •Growth rate
•Calorie needs
•Males 3000 cal/day
•Females 2000 cal/day
•Mineral and vitamin needs
•Provide food choices acceptable to teens
growth measurement -
•Measurement of weight, length, head circumference, body mass index (B M I)
•Use of gender- and age-specific growth charts
•Analysis of growth plots, proportionality, and patterns
growth charting exercise -
•Identify the child's percentiles (length and weight) based on the appropriate growth chart.
•Assign an appropriate nursing diagnosis (this may simply be health promotion) based on your findings, assuming no other problems
food security - Physical, social, and economic access at all times to safe and nutritious food sufficient to meet dietary needs and food preferences for an active and healthy life.
food insecurity - Inability to acquire or consume an adequate quality or sufficient quantity of food in socially acceptable ways, or the uncertainty that one will be able to do so
assessment for food insecurity - •Individual child nutritional status
•Identify family at risk
•Parents with food for child but without food for themselves
obesity - •A historic percentage of children are obese and overweight
Obesity definition - •Body mass index
•Risk at 85th percentile = overweight
influencing factors to obesity - •Decreased exercise patterns
•Television and other screen-based activities
•Percentage of calories as fat
•Snacking and fast food
nursing interventions for obesity - •Promotion and support of healthy lifestyle changes
•Families and children
•Joint, realistic goal setting
•Family education
•Diet
•Activity and exercise
•Television viewing, computer and videogame use
obesity evaluation - •Weight loss
•Diet changes
•Exercise
•Modification of cardiovascular risk factors
common nutritional deficiency - •Iron
•Calcium
•Vitamin D
•Folic acid
•Protein-energy malnutrition
types of infections - Bacterial
Viral
vFungal (ex: tinea capitis)
Zoonotic and vector‐borne (ex: rabies; Lyme disease)
Parasitic and helminthic (ex: pediculosis capitis [head lice]; roundworm)
Sexually transmitted infections (ex: chlamydia, HIV
preventing infection - Hand washing
Adequate immunization
Proper handling and preparation of food
"Antimicrobial stewardship"
Children and infection - -Due to the immature responses of the immune system, infants and young children are more susceptible to infection.
-The newborn displays a decreased inflammatory response to invading organisms, contributing to an increased risk for infection.
-Since the infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies, the risk of infection is higher.
-Disease protection from immunization is incomplete.
Airborne precautions - Methods of infection control that must be used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nuclei.
Droplet precautions - Must be followed for a patient known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing, sneezing, talking, or laughing.
contact precautions - practices used to prevent spread of disease by direct or indirect contact
CBC - Complete Blood Count (bloodwork to look for infection or anemia)
Erythrocyte sedimentation rate (ESR) - speed at which erythrocytes settle out of plasma
C-reactive protein (CRP) - blood test used to measure the level of inflammation in the body; may indicate conditions that lead to cardiovascular disease
nasal wash/swab -
'Point of care testing' (POCT) - a form of testing in which the analysis is performed where healthcare is provided close to or near the patient.
CSF - cerebrospinal fluid
Managing the Febrile Child - -Assess temperature at least every 4 to 6 hours, 30 to 60 minutes after antipyretic is given and with any change in condition
-Use same site and device for temperature measurement - technique
vOral, rectal, tympanic, temporal artery
-Administer antipyretics per provider order when the child is experiencing discomfort or cannot keep up with the metabolic demands of the fever
-Acetaminophen 15 mg/kg
-Ibuprofen 10 mg/kg
-Notify provider of temperature per institution or specific order guidelines
-Assess fluid intake and encourage oral intake or administer intravenous fluids per provider order - risk for dehydration
Viral illness - -URIs most common in children
-Usually self-limited (7-14 days); focus on symptom management, hydration
-Fever: acetaminophen 15 mg/kg PO/PR; ibuprofen 10 mg/kg PO
-Nausea: Ondansetron 0.15 mg/kg IV/PO
-Antivirals: Oseltamivir (influenza); Acyclovir (varicella; HSV)
Bacterial illness - -Symptom management and hydration
-Potential for sepsis - overwhelming bacterial infection
-Culture & sensitivity for proper antibiotic choice
-Amoxicillin/Augmention PO first line for OM/"strep throat"
-Ceftriaxone IM/IV for serious bacterial infections
Childhood Vaccination - -Many childhood diseases (both viral and bacterial) can be prevented with adequate immunization
-Many vaccinations require multiple doses
-Encourage annual vaccinations: influenza A/B, covid-19
Vaccine Hesitancy - -Extensive misinformation regarding safety and efficacy of vaccination creates fear and uncertainty
-Reality of vaccine-preventable disease passing out of living memory - causes imbalance in judgment
-Explore hesitancy with empathy
- Discuss alternatives (staggered schedule)
Otitis Externa - swimmers ear
Otitis Media - inflammation of the middle ear
OM treatment - OM - antibiotic; recurrent OM - tympanostomy tubes
Otalgia - pain in the ear
Antimicrobial stewardship - A coordinated program that promotes the appropriate use of antibiotics, which improves patient outcomes and reduces microbial resistance.
WBC with differential - blood test that shows blood levels for all the various leukocytes (granulocytes and agranulocytes)
negative pressure - air pressure that is less than atmospheric pressure for use with infected patients
postive pressure - the net airflow is flowing outward (out of the hood/room) to prevent contamination of the CSPs; used for preparing non-hazardous CSPs
- used for immunocompromised patients
Neutrophils - A type of white blood cell that engulfs invading microbes and contributes to the nonspecific defenses of the body against disease.
Lymphocytes - The two types of white blood cells that are part of the body's immune system: B lymphocytes form in the bone marrow and release antibodies that fight bacterial infections; T lymphocytes form in the thymus and other lymphatic tissue and attack cancer cells, viruses, and foreign substances.
Eosinophils - a white blood cell containing granules that are readily stained by eosin.
RSV - respiratory syncytial virus - a common cause of bronchiolitis, bronchopneumonia, and the common cold, especially in children (in tissue culture, forms syncytia or giant cells, so that cytoplasm flows together)
Antivirals for Influenza - Oseltamivir
antiviral/ HSV varicella tmt - Acyclovir
aceteminophen dose in children - 15mg/kg
ibuprofen dose in children - 10 mg/kg/dose
Nausea treatment - ondansetron
ondansetron dose in children - 0.15 mg/kg
amoxicillin indications/use - ear infection
strep throat
Ceftriaxone Indications in children - serious bacterial infection
craniostenosis (kray-nee-oh-steh-NOH-sis) - a malformation of the skull due to the premature closure of the cranial sutures
birth and head trauma risks - hemorrhage- brain is highly vascular
fracture
cervical spine injury
In the first 3-4 weeks gestation what can cause cns defects in children - infection
trauma
teratogens
malnutrition
cerebral blood flow - 10 times amount of oxygen used by the rest of the body
What should CPP be maintained at? - 70 mm
If ICP increases, what happens to CPP? - decreases
Autoregulation - the ability of tissues to regulate their own blood supply
medication that raises map - mannitol
full consciousness (LOC) - awake, alert, oriented, interacts with environment
confused LOC - lacks ability to think clearly and rapidly
Lethargic LOC - awakens easily but exhibits limited responsiveness
Obtunded - Less than full alertness (altered level of consciousness), typically as a result of a medical condition or trauma.
Stupor LOC - the client requires vigorous or painful stimuli (pinching a tendon or rubbing the sternum) to elicit a brief response;
she may not be able to respond verbally
coma - deep prolonged unconsciousness caused by disease, poison, or a severe blow
APVU scale - A method of assessing the level of consciousness by determining whether the patient is awake and alert, responsive to verbal stimuli or pain, or unresponsive; used principally early in the assessment process.
Glascow Coma Scale (GCS) - Neurologic assessment of a patient's best verbal response, eye opening, and motor function.
adverse neuro cues - n,v
pupillary change
headache
change in loc, and gait
;oss in motor function
visual disturbance
increased irritability
altered muscle tone
Infant Increased ICP Manifestations? - -Poor feeding or vomiting
-Irritability or restlessness
-Lethargy
-Bulging fontanelle
-High-pitched cry
-Increased head circumference
-Separation of cranial sutures
-Distended scalp veins
-Eyes deviated downward ("setting sun" sign)
-Increased or decreased response to pain
Children increased icp manifestations? - -Headache
-Diplopia ("double vision")
-Mood swings
-Slurred speech
-Papilledema (after 48 hours) (optic disk swelling)
-Altered level of consciousness
-Nausea and vomiting, especially in the morning
subarachnoid bolt - placed just through skull to monitor ICP but does not allow for CSF drainage
intraventricular cath - Tube placed in lateral ventricle or subarachnoid space; allows both pressure monitoring and drainage of excess CSF
Cushing's triad - Signs of increased intracranial pressure:
1. hypertension
2. bradycardia
3. irregular respirations
hydrocephalus - hydrocephalus caused by a problem with the normal uptake of CSF through the arachnoid granulations; whole CSF system would have increased pressure
Skull Fractures in Children - Great deal of force is required to produce a skull fracture in an infant
Fracture on the underside of the skull can tear the meningeal artery, causing severe hemorrhage with hypovolemic hypotension
contusion - bruise, injury
concussion - violent shaking up or jarring of the brain
intracranial hemorrhage - bleeding from ruptured vessels
epidural hematoma - a hematoma located on top of the dura
subdural hematoma - pertaining to below the dura mater, tumor of blood
focal seizure - localized seizure often affecting one limb
Generalized seizures - seizures that involve the entire brain
tonic-clonic seizure - generalized seizure in which the patient loses consciousness and has jerking movements of paired muscle groups
febrile seizures - Seizures that result from sudden high fevers, particularly in children.
Absent seizure - brief; lasts seconds; pt may or may not lose consciousness
No loss of change in muscle tone
May occur several times during the day
Appears to be daydreaming
More common in children
Meningitis - inflammation of the meninges of the brain and spinal cord
Vascular Headache- Migraine - supra-orbital, fronto-temporal with throbbing pain, often associated with visual disturbances
tension headache - occurs from long, endured contraction of the skeletal muscles around the face, scalp, upper back, and neck
rebound headache - Due to withdrawal of analgesic medications (e.g., NSAIDs)
Often misdiagnosed as chronic migraines, but will not respond to normal treatments
inflammatory headache - a symptom of an associated neurological problem such as hemorrhagic stroke, meningitis, or tumor
structural headache - Chronic, progressive (Increased ICP, space-occupying lesion)