PURPOSE: Recurrent headaches are common among Korean students, causing absences from school or learning impediments. However, most school nurses are unable to provide appropriate diagnosis and treatment as they lack accurate information about the clinical aspects or treatment of headaches. The aim of this study was to investigate school nurses's clinical knowledge, assessment, and management of headache and educational needs in headache management. METHODS: This was a cross-sectional study targeting 250 school nurses who participated in the training lecture hosted by and were working at elementary, middle, and high schools. Surveys with insufficient data were excluded. RESULTS: Participants were 237 school nurses; 122 elementary school nurses, 62 middle school nurses, and 53 high school nurses, with an average age of 42.4±8.8 years. In all, 58.2% of the school nurses responded that they had received headache education, 68.8% responded that they knew the classifications of a headache, and 38.4% responded that they knew a headache assessment method. Only, 29% had a protocol for headache treatment. The educational needs (0-7 points) of school nurses to manage students with headaches were 5.8 for headache knowledge education, 5.5 for acute pharmacotherapy, 5.0 for preventive pharmacotherapy, 6.0 for lifestyle modification, and 6.0 for complementary remedy. CONCLUSION: School nurses had high educational needs for headache management but, they had insufficient knowledge of headaches and had not a protocol for the headache management in most cases. It suggests that headache knowledge education should be performed and the standardized headache management guideline should be developed to improve the performance of school nurses.
Classification ; Cross-Sectional Studies ; Diagnosis ; Disease Management ; Drug Therapy ; Education ; Headache* ; Humans ; Learning ; Life Style ; Methods ; School Nursing

PURPOSE: Recurrent headaches are common among Korean students, causing absences from school or learning impediments. However, most school nurses are unable to provide appropriate diagnosis and treatment as they lack accurate information about the clinical aspects or treatment of headaches. The aim of this study was to investigate school nurses's clinical knowledge, assessment, and management of headache and educational needs in headache management. METHODS: This was a cross-sectional study targeting 250 school nurses who participated in the training lecture hosted by and were working at elementary, middle, and high schools. Surveys with insufficient data were excluded. RESULTS: Participants were 237 school nurses; 122 elementary school nurses, 62 middle school nurses, and 53 high school nurses, with an average age of 42.4±8.8 years. In all, 58.2% of the school nurses responded that they had received headache education, 68.8% responded that they knew the classifications of a headache, and 38.4% responded that they knew a headache assessment method. Only, 29% had a protocol for headache treatment. The educational needs (0-7 points) of school nurses to manage students with headaches were 5.8 for headache knowledge education, 5.5 for acute pharmacotherapy, 5.0 for preventive pharmacotherapy, 6.0 for lifestyle modification, and 6.0 for complementary remedy. CONCLUSION: School nurses had high educational needs for headache management but, they had insufficient knowledge of headaches and had not a protocol for the headache management in most cases. It suggests that headache knowledge education should be performed and the standardized headache management guideline should be developed to improve the performance of school nurses.
Classification ; Cross-Sectional Studies ; Diagnosis ; Disease Management ; Drug Therapy ; Education ; Headache* ; Humans ; Learning ; Life Style ; Methods ; School Nursing

Craniofrontonasal dysplasia(CFND), a rare congenital syndrome, is characterized by varying degrees of frontonasal dysplasia, craniosynostosis, and variable extracranial abnormalities. It was first reported by Cohen in 1979. The inheritance pattern is not straightforward. Although all modes of Mendelian inheritance have been suggested, the most plausible explanation is that this is an X-linked condition with the unusual situation of complete expression in females, and minimal to no expression in males. In our case, CFND was diagnosed in a female neonate who had unilateral coronal craniosynostosis, frontal bossing, orbital hypertelorism, broad nasal root, clefting nasal tip, corpus callosum agenesis and mild extremity abnormalities.
Agenesis of Corpus Callosum ; Craniosynostoses ; Extremities ; Female ; Humans ; Hypertelorism ; Infant, Newborn ; Inheritance Patterns ; Male ; Orbit ; Parturition* ; Wills

Headache is a frequent neurological symptom in children and adolescents. Recurrent headaches have a significant disabling effect, with consequences including school absenteeism, decreased participation in extracurricular activities, and poor academic performance, and are a risk factor for further chronic headaches and other pain syndromes that merit increased attention. The most common types of primary headache in children and adolescents are migraine and tension-type headache (TTH). In a recent survey of South Korean school students, 29.1% of schoolchildren reported having recurrent headaches. TTH was more frequent than recurrent migraine headaches (13.7% vs. 8.7%), and the frequency of migraine and TTH increased with age. The prevalence rate of TTH in urban areas was higher than in suburban and rural areas. A trend was found for more severe disabilities to occur in older children with headache. Children and adolescents with migraine had the most severe headache-related disabilities. The predictors of headache-related disability were found to be migraine, severe intensity of the headache, frequent headache, and a longer duration of symptoms before presentation. Children and adolescents with recurrent or significant headaches should be diagnosed and treated promptly to reduce headache-related disability and to improve their quality of life.
Absenteeism ; Adolescent* ; Child* ; Headache Disorders ; Headache* ; Humans ; Migraine Disorders ; Prevalence* ; Quality of Life ; Risk Factors ; Tension-Type Headache

Paroxysmal hemicrania (PH) is rare in children and not widely recognized. It is characterized by pain attacks and associated symptoms and signs similar to those experiencing cluster headaches, but the features have a shorter effect, are more frequent, and respond completely to indomethacin. Some patients with PH may experience slight pain across the midline. There are only four cases of bilateral PH in the literature and it is very rare in children. Here, I report the case of a 10-year-old female with bilateral PH diagnosed by the typical symptoms along with the favorable response to indomethacin therapy.
Child ; Cluster Headache ; Female ; Humans ; Hydrogen-Ion Concentration ; Indomethacin ; Paroxysmal Hemicrania

The ginkgo nuts are commonly eaten because of its nutritive value. It also taken as an herbal medicine for its antitussive and expectorant properties throughout Korea, Japan, and China. A range of symptoms of ginkgo nut intoxication including vomiting, abdominal pain, irritability, headaches, and seizures have been reported. It can be fetal in severe cases if emergency care was not available. It was discovered that the toxicity of ginkgo nuts was due to 4-O-methoxypyridoxine. The convulsion can be prevented by administration of anticonvulsants and pyridoxal phosphate. We report a 6-year-old male, without any past or family histories of epilepsy, who presented with generalized tonic clonic seizures. About 7 hours before the seizure, he had consumed approximately 40 roasted ginkgo nuts. He exhibited vomiting and abdominal pain 5 hours after ingestion. After treatment with diazepam and pyridoxal phosphate, his symptoms were resolved and electroencephalogram was normalized. We report on the patient and emphasize pediatricians and parents who have children should be recognizing that neurotoxicity of ginkgo nuts, particularity convulsion inducing effect, can occur occasionally.
Abdominal Pain ; Anticonvulsants ; Child ; China ; Diazepam ; Eating ; Electroencephalography ; Emergency Medical Services ; Epilepsy ; Ginkgo biloba ; Headache ; Herbal Medicine ; Humans ; Japan ; Korea ; Male ; Nutritive Value ; Nuts ; Parents ; Pyridoxal Phosphate ; Pyridoxine ; Seizures ; Vomiting

The principle of surgery of the parotid gland is adequate removal of the tumor with functional and anatomical preservation of all blanches of the facial nerve. There are two main surgical approaches to superficial or total conservative parotidectomy. Anterior approach and posterior approach. Preliminary identification of the main trunk of the facial nerve is probably the most favoured techniques, but identification of the peripheral blanches of the facial nerve, with subsequent Proximal dissection to the main trunk, is long established but less popular technique. We have prospectively experienced the low incidence of facial nerve damage in series of 55 conservative parotidectomies performed using the anterior approach. The techniques employed is described with a deport of results obtained in the belief that this approach warrants greater popularity and saute technique.
Facial Nerve ; Incidence ; Parotid Gland ; Prospective Studies

The relation between headache and diabetes mellitus (DM) is interesting. The pathogenesis of headache in diabetic patients has been suggested to stem from the fact that DM reduces vascular reactivity and causes numerous changes of neurotransmitters that may be relevant in the pathogenesis of migraines; however, this mechanism remains unclear. We report a 17-year-old female patient with newly diagnosed type 2 diabetes mellitus, without any past history and symptoms of diabetes mellitus, who presented with persistent severe headache for 10 days. She did not complain of any headache following DM treatment. The author recommends that pediatricians consider and investigate diabetes mellitus in cases of progressive or persistent headache or refractory headache with headache treatment.
Adolescent ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Female ; Headache ; Humans ; Neurotransmitter Agents

PURPOSE: To assess the prevalence and characteristics of headache comorbidity with epilepsy in children and adolescents in a specialty epilepsy clinic. METHODS: Two hundred twenty nine consecutive patients attending the Chosun University Hospital Pediatric Epilepsy Clinic (mean age 10.0+/-4.1 years, range 4-17, M:F ratio 1.1:1.0) were interviewed with a standardized headache questionnaire. Headache was classified according to the International Classification of Headache Disorders, 2nd Edition and epilepsy was classified according to the International League Against Epilepsy. Disability was assessed using pediatric migraine disability assessment (PedMIDAS). RESULTS: Of the 229 epilepsy patients, 86 (37.6%) had co-morbid headache. Of the headache patients, 64 (74.4%) had migraine (65.6%- migraine without aura, 20.3% - migraine with aura, 14.1% - probable migraine). The mean headache frequency was 7.2+/-8.4 per month, mean duration was 2.2+/-4.0 hours, mean severity was 5.2+/-2.2 out of 10, and mean PedMIDAS score was 13.0+/-35.4. The proportion of females was not higher in epilepsy with headache patients (48.8%) compared to epilepsy patients alone (48.0%). In the patients with migraine, 48.4% had complex partial seizures, 17.2% had simple partial seizures, and 34.4% had generalized seizures (P=0.368). A postictal association of migraine was reported in 18.8% with 17.2% reporting a preictal headache, and 7.8% reporting an ictal headache. CONCLUSION: The prevalence of headache in pediatric epilepsy is higher than that in general pediatric population, suggesting a co-morbidity of headache in epilepsy patients with migraine being the most frequent headache disorder. Altered cerebral excitability resulting in an increased occurrence of spreading depression may explain the headache comorbidity with epilepsy. Further studies are needed to assess the etiology of this co-morbidity as well as assess the frequency, duration, severity and disability response to antiepileptic drugs.
Adolescent* ; Anticonvulsants ; Child* ; Classification ; Comorbidity* ; Depression ; Epidemiology* ; Epilepsies, Partial ; Epilepsy* ; Female ; Headache Disorders ; Headache* ; Humans ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Prevalence ; Surveys and Questionnaires ; Seizures

Refractory status epilepticus (RSE) is defined as seizure activity that continues after treatment with conventional anticonvulsants. Mortality rates of range from 2% to 100%. RSE are associated with significant morbidity and high mortality as evidenced by older age of the patient, acute etiology for the seizure, no previous history of seizures, low initial Glasgow Coma Scale, and the significant duration of the RSE. An intravenous valproic acid (VPA) was suggested as a useful drug in controlling RSE. A continuous infusion VPA was an efficient method of rapidly achieving VPA concentrations in the upper region of the therapeutic range while minimizing adverse effects. A 10-year-old female suffered a generalized tonic clonic seizure that developed into refractory status epilepticus. Her Glasgow Coma Scale was deteriorated to 4. Status epilepticus was refractory to phenytoin, phenobarbital, midazolam, thiopental. After 4days of unsatisfactory control of seizure activity, high dose VPA was administered for 2 months. The clinical and electrolgraphic seizure improved and the patient has made an satisfactory neurologic recovery
Anticonvulsants ; Child ; Female ; Glasgow Coma Scale ; Humans ; Midazolam ; Phenobarbital ; Phenytoin ; Seizures ; Status Epilepticus ; Thiopental ; Valproic Acid