1
|
Ghosh A, Varghese L, Burish MJ, Szperka CL. Trigeminal Autonomic Cephalalgias and Neuralgias in Children and Adolescents: a Narrative Review. Curr Neurol Neurosci Rep 2023; 23:539-549. [PMID: 37572226 DOI: 10.1007/s11910-023-01288-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE OF REVIEW To summarize the available literature as well as the authors' experience on trigeminal autonomic cephalalgias (TACs) and cranial neuralgias in children and adolescents. RECENT FINDINGS While TACs and cranial neuralgias are rare in children, several recent case series have been published. TACs in children share most of the clinical features of TACs in adults. However, there are many reported cases with clinical features which overlap more than one diagnosis, suggesting that TACs may be less differentiated in youth. Indomethacin-responsive cases of cluster headache and SUNCT/SUNA have been reported in children, whereas in adults indomethacin is usually reserved for paroxysmal hemicrania and hemicrania continua. Neuralgias appear to be rare in children. Clinical features are often similar to adult cases, though clinicians should maintain a high index of suspicion for underlying causes.
Collapse
Affiliation(s)
- Ankita Ghosh
- Division of Child Neurology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Leena Varghese
- Pediatric Headache Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark J Burish
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Christina L Szperka
- Pediatric Headache Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
2
|
SUNCT/SUNA in Pediatric Age: A Review of Pathophysiology and Therapeutic Options. Brain Sci 2021; 11:brainsci11091252. [PMID: 34573272 PMCID: PMC8466007 DOI: 10.3390/brainsci11091252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 12/27/2022] Open
Abstract
The International Classification of Headache Disorders, 3rd edition (ICHD3) defines Short-lasting Unilateral Neuralgiform Headache Attacks (SUNHA) as attacks of moderate or severe, strictly unilateral head pain lasting from seconds to minutes, occurring at least once a day and usually associated with prominent lacrimation and redness of the ipsilateral eye. Two subtypes of SUNHA are identified: Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) and Short-lasting Unilateral Neuralgiform headache attacks with cranial Autonomic symptoms (SUNA). These pathologies are infrequent in children and difficult to diagnose. The authors reviewed the existing literature on SUNCT and SUNA, especially in the developmental age, which describes the pathophysiology in detail and focuses on the therapeutic options available to date. SUNHA-type headaches must be considered on the one hand, for the possibility of the onset of forms secondary to underlying pathologies even of a neoplastic nature, and on the other hand, for the negative impact they can have on an individual’s quality of life, particularly in young patients. Until now, published cases suggest that no chronic variants occur in childhood and adolescents. In light of this evidence, the authors offer a review that may serve as a source to be drawn upon in the implementation of suitable treatments in children and adolescents suffering from these headaches, focusing on therapies that are non-invasive and as risk-free as possible for pediatric patients.
Collapse
|
3
|
Ghosh A, Silva E, Burish MJ. Pediatric-onset trigeminal autonomic cephalalgias: A systematic review and meta-analysis. Cephalalgia 2021; 41:1382-1395. [PMID: 34407646 DOI: 10.1177/03331024211027560] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE There are five headache disorders composing the trigeminal autonomic cephalalgias (cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), and hemicrania continua). Little is known about these disorders in the pediatric population. The objectives of this study are to report the full age ranges of pediatric trigeminal autonomic cephalalgias and to determine if pediatric-onset trigeminal autonomic cephalalgias display similar signs and symptoms as adult onset. METHODS Search criteria in Medline Ovid, Embase, PsycINFO, and Cochrane Library were created by a librarian. The remainder of the steps were independently performed by two neurologists using PRISMA guidelines. Inclusion criteria for titles and abstracts were articles discussing cases of trigeminal autonomic cephalalgias with age of onset 18 or younger, as well as any epidemiological report on trigeminal autonomic cephalalgias (as age of onset data was often found in the results section but not in the title or abstract). Data extracted included age of onset, sex, and International Classification of Headache Disorders criteria for trigeminal autonomic cephalalgias (including pain location, duration, frequency, autonomic features, restlessness) and some migraine criteria (photophobia, phonophobia, and nausea). Studies that did not meet full criteria for trigeminal autonomic cephalalgias were examined separately as "atypical trigeminal autonomic cephalalgias"; secondary headaches were excluded from this category. RESULTS In all, 1788 studies were searched, 86 met inclusion criteria, and most (56) examined cluster headache. In cluster headache, onset occurred at every pediatric age (range 1-18 years) with a full range of associated features. Autonomic and restlessness features were less common in pediatric patients, while migrainous features (nausea, photophobia, and phonophobia) were found at similar rates. The sex ratio of pediatric-onset cluster headache (1.8, 79 male and 43 female) may be lower than that of adult-onset cluster headache. Data for other trigeminal autonomic cephalalgias, while more limited, displayed most of the full range of official criteria. The data for atypical trigeminal autonomic cephalalgias were also limited, but the most common deviations from the official criteria were abnormal frequencies and locations of attacks. CONCLUSIONS Trigeminal autonomic cephalalgias can start early in life and have similar features to adult-onset trigeminal autonomic cephalalgias. Specifically, pediatric-onset cluster headache patients display the full range of each criterion for cluster headache (except maximum frequency of six instead of eight attacks per day). However, cranial autonomic features and restlessness occur at a lower rate in pediatrics. Additional information is needed for the other trigeminal autonomic cephalalgias. As for expanding the ICHD-3 criteria for pediatric-onset trigeminal autonomic cephalalgias, we have only preliminary data from atypical cases, which suggests that the frequency and location of attacks sometimes extend beyond the official criteria.Trial Registration: This study was registered as a systematic review in PROSPERO (registration number CRD42020165256).
Collapse
Affiliation(s)
- Ankita Ghosh
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emma Silva
- Texas Medical Center Library, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mark J Burish
- Department of Neurosurgery, 12340University of Texas Health Science Center at Houston, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
4
|
Evers S, Summ O, Frese A. Very young age of onset in trigemino-autonomic cephalalgias - case report and review of the literature. Cephalalgia 2020; 40:1385-1388. [PMID: 32664738 DOI: 10.1177/0333102420942220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Trigemino-autonomic cephalalgias are very rare disorders and even rarer in children and adolescents. We report the onset of paroxysmal hemicrania in a very young girl and reviewed the scientific literature for similar cases. FINDINGS We describe the case of a 1.6-year-old girl with left-sided headache attacks fulfilling the criteria of paroxysmal hemicrania including prompt responsiveness to indomethacin. In addition, we detected at least two children for every trigemino-autonomic cephalalgias subtype with an age of under 7 years at the onset of the trigemino-autonomic cephalalgias. Remarkable features were a vast majority of chronic course from onset on and left-sided attacks. CONCLUSION Although very rare, trigemino-autonomic cephalalgias can occur even in very young children under the age of 6 years. This should be known in neuropaediatrics.
Collapse
Affiliation(s)
- Stefan Evers
- Faculty of Medicine, University of Münster, Münster, Germany.,Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany
| | - Oliver Summ
- Department of Neurology and Research Center of Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Achim Frese
- Faculty of Medicine, University of Münster, Münster, Germany.,Akademie für Manuelle Medizin, Münster, Germany
| |
Collapse
|
5
|
Abstract
Short-lasting unilateral neuralgiform headache attacks (SUNHA) is characterized by strictly unilateral trigeminal distribution pain that occurs in association with ipsilateral cranial autonomic features. There are two subtypes: short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). These disorders are rare but highly disabling. The management of SUNHA can be challenging. The abortive therapies are not generally useful as the attacks are relatively short-lasting. A myriad of pharmacological preventive treatments has been tried in single case reports or small series in an open-label fashion. Lamotrigine, as an oral preventive treatment, and lidocaine, as an intravenous transitional treatment, seems to be the most effective therapies. For medically intractable SUNHA, several surgical approaches have been tried. These include ablative procedures involving the trigeminal nerve or the Gasserian ganglion, microvascular decompression (MVD) of the trigeminal nerve, and neurostimulation techniques. MVD, occipital nerve stimulation, and ventral tegmental area deep brain stimulation have all been found to be effective in open-label series with relatively high-response rates. There is a considerable clinical, therapeutic, and radiological overlap between SUNCT, SUNA, and trigeminal neuralgia (TN). Despite being considered distinct conditions, the emerging evidence suggests a broader nosological concept of SUNCT, SUNA, and TN; these conditions may constitute a continuum of the same disorder, rather than separate clinical entities. Consideration needs to be given to classifying SUNHA with TN as a cranial neuralgia rather than as a trigeminal autonomic cephalalgia.
Collapse
Affiliation(s)
- Andrew Levy
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Manjit S. Matharu
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| |
Collapse
|
6
|
Abstract
Migraine and tension-type headaches are common primary headache disorders encountered among children and adolescents presenting to a pediatric clinic. At times, children present with a headache with unusual or peculiar features that can be alarming and perplexing. These can be in the form of a brief stabbing headache with lacrimation in one eye or a continuous headache locked to one side of the head or face. These headache syndromes tend to be more common among adults but, on occasion, are known to occur or have their onset during childhood. This review outlines some of the uncommon primary headache disorders in children and adolescents that may be encountered in a pediatric clinic. Knowledge of these interesting conditions may avert the need for immediate neurological consultation and prevent delays in initiating specific therapy. [Pediatr Ann. 2018;47(2):e69-e73.].
Collapse
|
7
|
Özge A, Faedda N, Abu-Arafeh I, Gelfand AA, Goadsby PJ, Cuvellier JC, Valeriani M, Sergeev A, Barlow K, Uludüz D, Yalın OÖ, Lipton RB, Rapoport A, Guidetti V. Experts' opinion about the primary headache diagnostic criteria of the ICHD-3rd edition beta in children and adolescents. J Headache Pain 2017; 18:109. [PMID: 29285570 PMCID: PMC5745373 DOI: 10.1186/s10194-017-0818-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/06/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The 2013 International Classification of Headache Disorders-3 (ICHD-3) was published in a beta version to allow the clinicians to confirm the validity of the criteria or to suggest improvements based on field studies. The aim of this work was to review the Primary Headache Disorders Section of ICHD-3 beta data on children and adolescents (age 0-18 years), and to suggest changes, additions, and amendments. METHODS Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the literature available on pediatric headache, they made observations and proposed suggestions for the primary headache disorders section of ICHD-3 beta data on children and adolescents. RESULTS Some headache disorders in children have specific features which are different from those seen in adults and which should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psycho-social basis in children and adolescents making primary headache disorders in children distinct from those in adults. CONCLUSIONS Several recommendations are presented in order to make ICHD-3 more appropriate for use with children.
Collapse
Affiliation(s)
- Aynur Özge
- Department of Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | - Noemi Faedda
- Phd program in Behavioural Neuroscience, Department of Paediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Amy A. Gelfand
- UCSF Headache Center and UCSF Benioff Children’s Hospital, Pediatric Brain Center 2330 Post St 6th Floor San Francisco, Campus Box 1675, San Francisco, CA 94115 USA
| | - Peter James Goadsby
- NIHR-Wellcome Trust King’s Clinical Research Facility, King’s College London, London, England
| | - Jean Christophe Cuvellier
- Division of Paediatric Neurology, Department of Paediatrics, Lille Faculty of Medicine and Children’s Hospital, Lille, France
| | - Massimiliano Valeriani
- Division of Neurology, Ospedale Pediatrico Bambino Gesù, Piazza Sant’Onofrio 4, 00165 Rome, Italy
- Center for Sensory-Motor Interaction Aalborg University, Aalborg, Denmark
| | - Alexey Sergeev
- Department of Neurology and Clinical Neurophysiology, University Headache Clinic, Moscow State Medical University, Moscow, Russia
| | - Karen Barlow
- Faculty of Medicine, University of Calgary, Alberta Children’s Hospital, C4-335, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8 Canada
| | - Derya Uludüz
- Cerrahpaşa Medical Faculty, Department of Neurology, İstanbul University, Kocamustafapaşa, İstanbul, Turkey
| | - Osman Özgür Yalın
- İstanbul Research and Education Hospital, Kocamustafapaşa, İstanbul, Turkey
| | - Richard B. Lipton
- Department of Neurology Montefiore Headache Center, Albert Einstein College of Medicine, Louis and Dora Rousso Building, 1165 Morris Park Avenue, Room 332, Bronx, NY 10461 USA
| | - Alan Rapoport
- The David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Vincenzo Guidetti
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University, Rome, Italy
| |
Collapse
|
8
|
Cefalee del bambino. Neurologia 2016. [DOI: 10.1016/s1634-7072(16)78792-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
9
|
Liapounova NA, VanderPluym JH, Bhargava R, Kolski HH. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing-like attacks in a pediatric patient found to have a pontine capillary telangiectasia and developmental venous anomaly: A case report exploring the root of the problem. Cephalalgia 2016; 37:1093-1097. [PMID: 27342226 DOI: 10.1177/0333102416657148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)-like attacks are rarely reported in the pediatric population and may remain undiagnosed and under-investigated as a result. Case presentation We present a case of a 15-year-old male with intermittent, episodic, right-sided brief headaches most in keeping with SUNCT, initially diagnosed as paroxysmal hemicrania, but with no response to indomethacin. The pain was likewise not responsive to typical migraine treatments or steroids. Management and outcome Contrast-enhanced magnetic resonance imaging demonstrated a right pontine capillary telangiectasia with an associated developmental venous anomaly that was adjacent to the root of the right trigeminal nerve. Differential diagnosis included first division trigeminal neuralgia with autonomic features. The patient's pain was partially alleviated by oxygen administration and responded well to carbamazepine; he remained pain free on carbamazepine a year later. Conclusion This case highlights the diagnostic dilemma of differentiating SUNCT from trigeminal neuralgia with autonomic features, both of which are rare diagnoses in pediatric patients, and the importance of appropriate neuroimaging to rule out secondary causes in patients presenting with trigeminal autonomic cephalalgias, recognizing that abnormalities identified on neuroimaging, such as vessels adjacent to the trigeminal nerve, may not be causative findings.
Collapse
Affiliation(s)
- Natalia A Liapounova
- 1 Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| | | | - Ravi Bhargava
- 2 Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Hanna H Kolski
- 1 Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
10
|
Abstract
Short-lasting headaches have been studied infrequently in children and it is not known if the main categories of primary headaches of this type in adults are applicable to children. We report our experience with a group of 20 children with a brief headache. Two patients had a secondary headache. One patient had a headache with some clinical characteristics of paroxysmal hemicrania. The remaining 17 had a very brief headache. They were in many aspects comparable to others from previous studies on idiopathic stabbing headache in children: no associated symptoms, no other associated headache, frequent family history of migraine. They differed, however, in the younger age of the patients and the more frequent extratrigeminal location of the pain. Extratrigeminal ice-pick pain may be a variant of idiopathic stabbing headache, more prevalent in young children.
Collapse
Affiliation(s)
- J P Vieira
- Serviço de Neurologia, Hospital de Dona Estefânia, Lisboa, Portugal.
| | | | | |
Collapse
|
11
|
Botulinum Toxin A for the Treatment of a Child with SUNCT Syndrome. Pain Res Manag 2016; 2016:8016065. [PMID: 27445629 PMCID: PMC4904625 DOI: 10.1155/2016/8016065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/09/2015] [Indexed: 01/03/2023]
Abstract
Background. Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome is an unusual cause of headache, mainly described in older adults, and is rare in children. Pain attacks may be severe, frequent, and prolonged. The therapeutic benefits of many drugs are disappointing. Patient and Methods. A 12-year-old boy suffered severe headache and toothache for 20 days. As treatment with nonsteroidal anti-inflammatory drugs, anticonvulsants, and steroids proved ineffective, he was treated with ipsilateral multisite subcutaneous injections of botulinum toxin A 70 U around the orbit, the temporal area, and the upper gum. Results. The pain had reduced in frequency and severity by the fourth day after treatment and had completely disappeared after 7 days. There were no side effects or recurrence during a subsequent 17-month follow-up period. Conclusion. Botulinum toxin A can be used to treat the first episode of SUNCT in children over the age of 12 years.
Collapse
|
12
|
McAbee GN. A review of episodic and chronic pediatric headaches of brief duration. Pediatr Neurol 2015; 52:137-42. [PMID: 25499092 DOI: 10.1016/j.pediatrneurol.2014.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/10/2014] [Accepted: 10/17/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Headaches that last less than an hour in duration are uncommon, except for atypical migraine, and without a practitioner's appropriate knowledge, may result in misdiagnosis. Although most of these headaches are classified as primary headache syndromes, some have secondary etiologies such as structural lesions. METHODS This pediatric-specific review updates these headache syndromes. Included are atypical migraine, the trigeminal autonomic cephalgias, idiopathic stabbing headache, cranial neuralgias, occipital neuralgia, thunderclap headache, nummular headache, the red ear syndrome, and the numb-tongue syndrome. CONCLUSION Knowledge of the clinical characteristics of these headache patterns in children allows physicians to quickly establish the headache diagnosis and develop the optimal treatment plan.
Collapse
Affiliation(s)
- Gary N McAbee
- Department of Pediatrics, CarePoint Health Medical Group, Jersey City, New Jersey; Department of Neuroscience, Seton Hall University, School of Health & Medical Sciences, South Orange, New Jersey.
| |
Collapse
|
13
|
Robbins MS, Ailani J. Epidemiology, Progression, Prognosis, and Comorbidity of Trigeminal Autonomic Cephalalgias. Headache 2013. [DOI: 10.1002/9781118678961.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
14
|
Lambru G, Matharu M. Management of Trigeminal Autonomic Cephalalgias in Children and Adolescents. Curr Pain Headache Rep 2013; 17:323. [DOI: 10.1007/s11916-013-0323-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
15
|
Toldo I, De Carlo D, Mardari R, De Palma L, Gatta M, Bolzonella B, Nosadini M, Bartolini L, Sartori S, Battistella PA. Short lasting activity-related headaches with sudden onset in children: a case-based reasoning on classification and diagnosis. J Headache Pain 2013; 14:3. [PMID: 23565626 PMCID: PMC3606961 DOI: 10.1186/1129-2377-14-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short lasting headaches related to activity or cough are rare, particularly in childhood, and can be difficult to diagnose, especially in young children who are not able to describe their symptoms. In the literature there are few data on this topic in adults and the paediatric cases reported are even more rare. FINDINGS We present the clinical history of a 7-year-old child and a 3-year-old child both diagnosed as having activity-related headaches, characterized by sudden onset of short lasting (few seconds) attacks, that were triggered by cough or exercise. There were no accompanying symptoms and the neurological examination was normal in both cases. Brain magnetic resonance imaging showed, in the first case, a cerebellar pilocytic astrocytoma and, in the second case, a Chiari 1 malformation. Both cases received an early diagnosis, were surgically treated and had a good prognosis at follow-up. CONCLUSIONS When headache has a recent onset, it presents suddenly, and it is triggered by strain, even with normal neurological examination, neuroimaging is mandatory in order to exclude secondary headaches, especially in children.
Collapse
Affiliation(s)
- Irene Toldo
- Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Via Giustiniani, 3, 35128, Padova, Italy
| | - Debora De Carlo
- Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Via Giustiniani, 3, 35128, Padova, Italy
| | - Rodica Mardari
- Institute of Neuroradiology, Padua Hospital, Padua, Italy
| | - Luca De Palma
- Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Via Giustiniani, 3, 35128, Padova, Italy
| | - Michela Gatta
- Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Via Giustiniani, 3, 35128, Padova, Italy
| | - Barbara Bolzonella
- Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Via Giustiniani, 3, 35128, Padova, Italy
| | - Margherita Nosadini
- Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Via Giustiniani, 3, 35128, Padova, Italy
| | - Luca Bartolini
- Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Via Giustiniani, 3, 35128, Padova, Italy
| | - Stefano Sartori
- Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Via Giustiniani, 3, 35128, Padova, Italy
| | - Pier Antonio Battistella
- Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Via Giustiniani, 3, 35128, Padova, Italy
| |
Collapse
|
16
|
Pareja JA, Álvarez M, Montojo T. SUNCT and SUNA: Recognition and Treatment. Curr Treat Options Neurol 2012; 15:28-39. [DOI: 10.1007/s11940-012-0211-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
17
|
|
18
|
Sciruicchio V, Sardaro M, Gagliardi D, Trabacca A, Galeone D, de Tommaso M. A case of early-onset and monophasic trigeminal autonomic cephalalgia: could it be a SUNCT? J Headache Pain 2010; 11:363-5. [PMID: 20473543 PMCID: PMC3476350 DOI: 10.1007/s10194-010-0219-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 04/20/2010] [Indexed: 11/03/2022] Open
Abstract
A 2-year-old female came to the Neurological Emergency Room of "Giovanni XXIII" Hospital in Bari, 6 h after the onset of severe facial pain, which occurred soon after awakening. Stabbing pain affected the right frontal and periorbital area, with ipsilateral conjunctival injection, swelling of the eyelids and tearing. Except the duration, from 5 to 30 s., the attacks were stereotyped including the occurrence and features of autonomic signs. Based on the typical clinical findings and the normal magnetic resonance imaging (MRI), we diagnosed short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome (SUNCT). The spontaneous remission within a few hours made prophylactic therapy unnecessary. At the last follow-up, after 3 months, the patient was still symptom free. In our case, after an active period lasting 2 days the disease disappeared completely. However the typical features of the disease (unilateral pain, short duration and high frequency of the attacks, autonomic signs ipsilateral to pain, numbers of attacks) were all present. While the diagnostic criteria of the International Headache Society classification for SUNCT did not include the duration of disease, it is likely that the active period lasting 2 days could be an expression of the clinical variability of the disease.
Collapse
|
19
|
Affiliation(s)
- Ann Pakalnis
- Division of Pediatric Neurology, Ohio State University, USA
| | | |
Collapse
|
20
|
Blankenburg M, Hechler T, Dubbel G, Wamsler C, Zernikow B. Paroxysmal Hemicrania in Children—Symptoms, Diagnostic Criteria, Therapy and Outcome. Cephalalgia 2009; 29:873-82. [DOI: 10.1111/j.1468-2982.2008.01813.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Whereas paroxysmal hemicrania (PH) is studied extensively in adults, even case reports of PH in children are rare. We present the first prospective follow-up study on PH in children. Our aim was to investigate whether differences exist between paediatric and adult patients. We assessed all children with chronic headache who were referred to our paediatric out-patient pain clinic within 3 years based on interviews and validated questionnaires. Among 628 patients we found five children with PH (0.8%) and three with probable PH (0.5%), in total 1.3%. Pain characteristics, autonomic symptoms and treatment response to indomethacin were similar to adult PH patients. Our results demonstrate that the International Headache Society classification of PH is also applicable to children. We suspect that PH has been underdiagnosed in children and therefore suboptimally treated thus far.
Collapse
Affiliation(s)
- M Blankenburg
- Vodafone Foundation Institute for Children's Pain Therapy and Paediatric Palliative Care (VIKP), Clinic for Children and Adolescents Datteln, University Witten/Herdecke, Datteln, Germany
| | - T Hechler
- Vodafone Foundation Institute for Children's Pain Therapy and Paediatric Palliative Care (VIKP), Clinic for Children and Adolescents Datteln, University Witten/Herdecke, Datteln, Germany
| | - G Dubbel
- Vodafone Foundation Institute for Children's Pain Therapy and Paediatric Palliative Care (VIKP), Clinic for Children and Adolescents Datteln, University Witten/Herdecke, Datteln, Germany
| | - C Wamsler
- Vodafone Foundation Institute for Children's Pain Therapy and Paediatric Palliative Care (VIKP), Clinic for Children and Adolescents Datteln, University Witten/Herdecke, Datteln, Germany
| | - B Zernikow
- Vodafone Foundation Institute for Children's Pain Therapy and Paediatric Palliative Care (VIKP), Clinic for Children and Adolescents Datteln, University Witten/Herdecke, Datteln, Germany
| |
Collapse
|
21
|
|
22
|
Affiliation(s)
- Aycan Unalp
- Department of Pediatric Neurology, Dr. Bechet Uz Child Disease and Pediatric Surgery Educational and Research Hospital, Izmir, Turkey.
| | | |
Collapse
|
23
|
Klasser GD, Balasubramaniam R. Trigeminal autonomic cephalalgias. Part 3: short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. ACTA ACUST UNITED AC 2007; 104:763-71. [PMID: 17689116 DOI: 10.1016/j.tripleo.2007.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Revised: 04/18/2007] [Accepted: 04/25/2007] [Indexed: 10/23/2022]
Abstract
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a syndrome characterized by severe, strictly unilateral short-lasting (between 5 and 240 seconds) pain localized to orbital, supraorbital, and temporal areas, accompanied by ipsilateral conjunctival injection and lacrimation. It represents 1 of 3 primary headaches classified as trigeminal autonomic cephalalgias (TACs). Although its prevalence is extremely small, SUNCT patients may present at dental offices seeking relief for their pain. It is important for oral health care providers to recognize SUNCT and render an accurate diagnosis. This will avoid the pitfall of implementing unnecessary and inappropriate traditional dental treatments in hopes of alleviating this neurovascular pain. The following article is part 3 of a review on TACs and focuses on SUNCT. Aspects of SUNCT, including epidemiology, genetics, pathophysiology, clinical presentation, classification and variants, diagnosis, medical management, and dental considerations are discussed.
Collapse
Affiliation(s)
- Gary D Klasser
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | | |
Collapse
|
24
|
Abstract
Headaches represent one of the most common reasons why children and adolescents seek medical attention and are the primary reason that they are referred to pediatric neurology practices. The most common headache syndromes diagnosed are migraine, tension-type, and chronic daily headache, and the bulk of recent medical literature regarding headache in children has focused on these clinical entities. Children are prone to have unusual headache syndromes, most of which fall under the category of "primary headache," most notably as manifestations of migraine with aura. Included within this group are basilar-type and hemiplegic migraine. The most intriguing subset included in the International Headache Society's classification system is the so-called "periodic syndromes of childhood that are precursors to migraine." These syndromes, quite peculiar to children, present a wide variety of episodic symptoms, including movement disorders, vomiting, ataxia, and vertigo, and may not include headache at all. This article provides an overview of some of the more unusual headache syndromes in children and adolescents.
Collapse
Affiliation(s)
- Michelle Brenner
- Department of Pediatrics, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, 850 Southampton Avenue, Norfolk, VA 23510, USA
| | | | | |
Collapse
|
25
|
Millichap JG. SUNCT Syndrome in a Child. Pediatr Neurol Briefs 2005. [DOI: 10.15844/pedneurbriefs-19-10-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|