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Gentile CP, Aguirre GK, Hershey AD, Szperka CL. Symptoms associated with headache in youth. Cephalalgia 2023; 43:3331024231187162. [PMID: 37435790 PMCID: PMC10852031 DOI: 10.1177/03331024231187162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To determine the underlying relationships between a broad range of headache-associated symptoms and how they relate to headache burden. BACKGROUND Symptoms associated with head pain inform classification of headache disorders. However, many headache-associated symptoms are not included in the diagnostic criteria, which is largely based on expert opinion. Large symptom databases can assess headache-associated symptoms irrespective of pre-existing diagnostic categories. METHODS We conducted a large single-center cross-sectional study on youth (6-17 years old) assessing patient-reported outpatient headache questionnaires between June 2017 and February 2022. Multiple correspondence analysis, an exploratory factor analysis, was applied to 13 headache-associated symptoms. RESULTS 6662 participants (64% female; median age 13.6 years) were included. Multiple correspondence analysis dimension 1 (25.4% of the variance) captured the absence or abundance of headache-associated symptoms. A greater number of headache-associated symptoms correlated with greater headache burden. Dimension 2 (11.0% of the variance) revealed three symptom clusters: (1) cardinal features of migraine (light, sound, and smell sensitivity, nausea, and vomiting), (2) nonspecific global neurologic dysfunction symptoms (lightheadedness, trouble thinking, blurry vision), (3) vestibular and brainstem dysfunction symptoms (vertigo, balance problems, ear ringing, double vision). CONCLUSION Assessing a broader range of headache-associated symptoms reveals clustering of symptomatology and a strong relationship with headache burden.
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Affiliation(s)
- Carlyn Patterson Gentile
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Geoffrey K. Aguirre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Andrew D. Hershey
- Cincinnati Children’s Hospital Medical Center & University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christina L. Szperka
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Kurtul BE, Sipal C, Akbas Y. Assessment of the Optic Disc and Retinal Microvasculature by Optical Coherence Tomography Angiography in Patients With Pediatric Migraine. J Neuroophthalmol 2023; 43:191-196. [PMID: 35921585 DOI: 10.1097/wno.0000000000001697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Migraine, as a chronic neurovascular disease, is known to be a risk factor for retinal and optic nerve head damage. Herein, we aimed to evaluate the optic disc and retinal microvasculature in pediatric migraine (PM) patients using optical coherence tomography angiography (OCTA). METHODS Forty-six eyes of 23 patients with PM without aura (PM group) and 46 eyes of 23 age- and sex-matched healthy subjects (control group) were included in this cross-sectional prospective study. Demographic features and ophthalmological examination including OCTA measurements were evaluated. OCTA was performed with 6- × 6-mm sections for macula and 4.5- × 4.5-mm sections for optic nerve head in all eyes. Foveal retinal thickness (FRT), peripapillary retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of the retina, and optic disc were analyzed and compared between the groups. All measurements of the PM patients were taken in the attack-free period. RESULTS The mean ages of the PM group and control group were 11.17 ± 3.3 and 11.83 ± 2.8 years, respectively ( P = 0.479). Gender and mean intraocular pressures were similar between the groups. The mean central corneal thickness levels in the PM group were significantly lower than control group, 548.28 ± 26.3 µm and 562.04 ± 24.5 µm, respectively ( P = 0.011). There was no significant difference regarding average and all quadrant RNFL thicknesses, foveal avascular zone and flow areas, deep vessel densities, and optic disc capillary densities between the groups. However, compared with the control group, the PM group showed significant higher values of FRT, and lower values of superficial whole and parafoveal vessel densities (247.28 ± 15.8 µm vs 285.93 ± 11.1, P < 0.001, 51.85 ± 2.4% vs 50.31 ± 4.0%, P = 0.02, 55.09 ± 2.3% vs 53.5 ± 3.5%, P = 0.01, respectively). Disease duration and attacks/year did not show any significant correlations with OCTA values. CONCLUSIONS PM seems to be associated with lower superficial whole and parafoveal vessel densities because of hypoperfusion and ischemia. OCTA may be suggested for use in follow-up and management of PM patients.
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Affiliation(s)
- Bengi Ece Kurtul
- Tayfur Ata Sökmen Faculty of Medicine (BEK), Department of Ophthalmology, Hatay Mustafa Kemal University, Hatay, Turkey; Tayfur Ata Sökmen Faculty of Medicine (CS), Department of Ophthalmology, Mustafa Kemal University, Hatay, Turkey; and Tayfur Ata Sökmen Faculty of Medicine (YA), Department of Pediatric Neurology, Hatay Mustafa Kemal University, Hatay, Turkey
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ŞİMDİVAR GHN, SARIGEÇİLİ E, İNCEKALAN T, KOÇ UÇAR H. Oküler biyometrik ölçümler ile pediatrik migren arasında ilişki. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1087155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Bu çalışmada pediatrik migren hastalarında biyometri ölçümlerinin ve ön segment parametrelerinin değerlendirilmesi ve sağlıklı çocuklarla karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Bu prospektif vaka-kontrol çalışmasına yaş ve cinsiyeti uyumlu 40 pediatrik migren hastası ve 45 sağlıklı çocuk dahil edildi. Ölçümlerden önce tüm katılımcılar tam bir oftalmolojik muayeneden geçirildi. Ön kamara derinliği (ÖKD), vitreus uzunluğu (VU), lens kalınlığı (LK), aksiyel uzunluk (AU), merkezi kornea kalınlığı (MKK), kornea hacmi (KH), ön kamara hacmi (ÖKH), iridokorneal açı (İKA), pupil çapı (PÇ) ve ortalama kornea kırıcılığı (Km) değerlendirildi. Tüm değerlendirmeler ataksız dönemde yapıldı. Fotofobisi olan ve olmayan migrenli hastalarda pupil çapı karşılaştırıldı. Diürnal varyasyondan en az oranda etkilenmek açısından göz içi basınç ölçümleri ve biyometri değerlendirmeleri günün aynı saatlerinde (10:00–12:00) yapıldı. Tüm katılımcıların sağ gözü çalışmaya dahil edildi.
Bulgular: Pediatrik migren grubuyla (27 kız, 13 erkek) kontrol grubu (30 kız, 15 erkek) arasında ÖKD, VU, LK, AU, MKK, KH, ÖKH, İKA, PÇ, göz içi basıncı, sferik eşdeğer ve Km ölçümleri bakımından istatistiksel olarak anlamlı farklılık görülmedi. Migren grubu içerisinde fotofobisi olan hastalar ile olmayanların pupil çapları arasında anlamlı farklılık görülmedi.
Sonuç: Pediatrik migren hastalarında biyometri, korneal topografi ve keratometri ölçümlerinde sağlıklı çocuklara göre farklılık görülmemektedir. Pediatrik migren ile oküler biyometrik ölçümler arasındaki ilişkiyi incelemek için daha geniş hasta popülasyonlu çalışmalara ihtiyaç vardır.
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Affiliation(s)
| | - Esra SARIGEÇİLİ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Tuğba İNCEKALAN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Habibe KOÇ UÇAR
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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Abu-Arafeh I. Predicting quality of life outcomes in children with migraine. Expert Rev Neurother 2022; 22:291-299. [PMID: 35263201 DOI: 10.1080/14737175.2022.2051481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Several studies have shown that the response of children with migraine to medications is suboptimum and inferior to the response reported in adults, despite the similar pathogenesis and biological mechanisms. The poor response may be related to the significant differences that make assessment and treatment of children with migraine more challenging than in adults. AREAS COVERED The purpose of this review is to discuss the whole process of assessment of children with migraine, the necessary skills for eliciting the clinical features, making the correct diagnosis and exploring lifestyle issues, co-morbid conditions (psychological and physical) and social influences on disease presentations. Also, to establish and address peculiarities of migraine in children that would enable clinicians to advise on lifestyle modifications, co-morbid conditions and the correct choice of treatment options including non-pharmacologic therapies and medications. EXPERT OPINION The choice of treatment should be based on an assessment of each individual child taking into account, age, gender, pubertal status, body weight, comorbid disorders and family history. Also considering the profile of migraine episodes, frequency, duration, associated symptoms and effects of nausea and vomiting. Using the appropriate medications in appropriate dosage, formulation and route and timing of administration may improve adherence to treatment and outcome.
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Affiliation(s)
- Ishaq Abu-Arafeh
- Paediatric Neurosciences Unit, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
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Genizi J, Bugdnoskya V, Aboud A, Segal I, Assaf N, Srugo I, Kerem NC. Migraine and Tension-Type Headache Among Children and Adolescents: Application of International Headache Society Criteria in a Clinical Setting. J Child Neurol 2021; 36:618-624. [PMID: 33507829 DOI: 10.1177/0883073820988417] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The International Headache Society criteria were written in order to help physicians establish a headache diagnosis. However, sometimes children with headache do not seem to fit any diagnosis. The purpose of our study was to assess the application of the criteria in a clinical setting. METHODS Medical records of children referred for primary headache to the pediatric neurology clinic at Bnai Zion Medical Center from 2008 to 2017 were assessed. RESULTS A total of 989 patients (range 6-18 years; 53% female) were assessed at our neurology clinic. Twenty-four percent (n = 241) were diagnosed with tension-type headache, 26% (n = 256) with migraine, and 4.5% (45) with mixed headache. In 41.5% (410), we were unable to reach a specific diagnosis. No differences in gender or age were found between the groups. Children in the migraine group used more analgesic treatments to stop the headache attacks compared with the tension-type headache group (50% vs 38%, P = .001). Patients diagnosed with tension-type headache reported having more emotional difficulties (P = .001). No significant differences were found in headache characteristics (ie, location, sidedness, character), frequency, or intensity between the younger children (ages 6-11) and the adolescents (ages 12-18) within either the tension-type headache or migraine groups. CONCLUSIONS Retrospective application of International Headache Society criteria in a large cohort of children with headaches failed to diagnose a specific type of headache in 41.5% of children. Migraine and tension-type headache were equally prevalent, and both constituted a major burden on our patients' everyday lives. We found no major differences in frequency, intensity, and characteristics of pain between younger children and adolescents.
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Affiliation(s)
- Jacob Genizi
- Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel.,Pediatric Department, Bnai Zion Medical Center, Haifa, Israel.,Bruce Rappaport Faulty of Medicine, Technion, Haifa, Israel
| | - Vera Bugdnoskya
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Amer Aboud
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Idan Segal
- Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel.,Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Nurit Assaf
- Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Isaac Srugo
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel.,Bruce Rappaport Faulty of Medicine, Technion, Haifa, Israel
| | - Nogah C Kerem
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel.,Adolescent Medicine Unit, Bnai Zion Medical Center, Haifa, Israel.,Bruce Rappaport Faulty of Medicine, Technion, Haifa, Israel
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Abstract
PURPOSE OF REVIEW This article reviews the approach to a child or adolescent with headache, the criteria for common diagnoses, and the evidence base for treatments. RECENT FINDINGS The guidelines for acute and preventive treatment of migraine were updated in 2019. These guidelines summarize the available evidence and outline the questions that should be addressed in future research. The US Food and Drug Administration (FDA) approval of several new classes of drugs and devices to treat adult migraine in the past few years has resulted in ongoing or planned pediatric trials. SUMMARY Headache is a common symptom in children, and it is important to take a detailed history and perform a thorough physical examination to make the diagnosis. Nearly 1 in 10 children experience recurrent headaches due to migraine, which cause significant impairment in school performance and quality of life. The acute and preventive treatments that are currently available will help at least two-thirds of children with migraine, and several trials of new therapies offer hope for the future.
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Raieli V, D'Amico A, Piro E. Migraine in Children Under 7 Years of Age: a Review. Curr Pain Headache Rep 2020; 24:79. [PMID: 33326057 DOI: 10.1007/s11916-020-00912-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Despite the accumulation of a significant amount of data on pediatric headache, few studies have been conducted on its occurrence in children under 7 years of age. Within primary headaches in this age, migraine especially, turns out to be a disorder affecting up to 4% of the general population. An underestimate of its true prevalence can be due to lack of specific diagnostic markers, the frequent difficulty of describing pain in childhood, and the necessity of reliable parents' reports. Thus, migraine in children under 7 years of age represents an important challenge for clinicians. The objective of this manuscript is to provide a comprehensive review of epidemiologic, clinic, and therapeutic aspects of migraine in this age. RECENT FINDINGS Current literature data show that migraine has some differences, especially in clinical and therapeutic terms, in this age group compared to subsequent ages. Furthermore, some evidences showing that an early onset of migraine may play an unfavorable role in its natural history, suggest an early identification and management of migraine in younger children. Moreover, we highlight the role that factors of prenatal and perinatal development can play in the predisposition and anticipation of migraine onset. Finally, open questions related to the several undefined features of migraine in this age are reported. Migraine in this pediatric population is absolutely not rare, represents an importan clinical challenge and probably has a negative predictive role.
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Affiliation(s)
- Vincenzo Raieli
- Child Neuropsychiatry Unit- ISMEP -P.O. Cristina - ARNAS Civico, via dei Benedettini 1, Palermo, Italy.
| | - Antonina D'Amico
- Department for Health Promotion, Maternal Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro," Child Neuropsychiatry School, University Hospital "P. Giaccone", Via A. Giordano 3, 90127, Palermo, Italy
| | - Ettore Piro
- Department for Health Promotion, Maternal Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro," Neonatal Intensive Care Unit, University Hospital "P. Giaccone", Via A. Giordano 3, 90127, Palermo, Italy
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Marchese F, Rocchitelli L, Messina LM, Nardello R, Mangano GD, Vanadia F, Mangano S, Brighina F, Raieli V. Migraine in children under 6 years of age: A long-term follow-up study. Eur J Paediatr Neurol 2020; 27:67-71. [PMID: 32334992 DOI: 10.1016/j.ejpn.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/23/2019] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Early starting of migraine seems predictive for less favorable outcome in later ages, however follow-up investigations are very few and all with short-term prospective period. We report here the longest follow-up study in a population of children presenting with migraine under the age of 6. METHODS We followed-up 74 children under 6 years of age, referred for headache to our department between 1997 and 2003. The study was carried out between October 2016 and March 2018. Headache diagnoses were made according to the IHS criteria. RESULTS 23/74 patients, 31% of the original cohort, were found at follow-up in a period ranging between 15 to 21 years after the first visit. Seven of them were headache free. The remaining 16 patients had migraine. In the migraine group, the localization of pain changed in 75% of the subjects, 11/16 (68.7%) had allodynia and 9/16 (56.25%) had cranial autonomic symptoms. CONCLUSIONS Our results suggest that the onset of migraine at very young age represents unfavorable prognostic factor for persistence of the disease at later ages. Some clinical features may change during clinical course, and the active persistence of the disorder may lead to an increase in allodynia.
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Affiliation(s)
- Francesca Marchese
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Luciana Rocchitelli
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Luca Maria Messina
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Rosaria Nardello
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Giuseppe Donato Mangano
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Francesca Vanadia
- Child Neuropsychiatry Dept., P.O. Di Cristina, ARNAS Civico Palermo, Italy
| | - Salvatore Mangano
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Filippo Brighina
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Dept., P.O. Di Cristina, ARNAS Civico Palermo, Italy.
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Topographic changes measured by the swept source optical coherence tomography in retinal nerve fiber layer, optic nerve head and macula in children with migraine. Acta Neurol Belg 2020; 120:661-668. [PMID: 30895457 DOI: 10.1007/s13760-019-01123-5] [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] [Received: 12/22/2018] [Accepted: 03/11/2019] [Indexed: 01/03/2023]
Abstract
As a vascular-inflammatory disease, migraine affects the brain and some other organs, such as the eye. The aim of this study was to measure and compare the peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell layer thickness and optic nerve head parameters to detect structural damage in children with migraine using swept-source optical coherence tomography. Twenty-four children with migraine in the painless period and 26 controls were included in the study. The vast majority of the groups consisted of females (75% for patients and 77% for controls). Certain RNFL quadrants and optic disc parameters revealed significant differences between the patients and controls. In the right and left eyes of children with migraine, nasal quadrant RNFL was significantly thicker than that in healthy subjects (88.82 ± 11.03 vs 77.80 ± 13.77, P = 0.004 for right eyes and 87.71 ± 11.79 vs 77.80 ± 13.77, P = 0.01 for left eyes). Temporal quadrant RNFL in the left eyes was thinner (78.67 ± 9.57 vs 84.44 ± 9.68, P = 0.04). Disc area in the left eyes of the patients was greater (2.29 ± 0.46 vs 1.94 ± 0.28, P = 0.003). There were significant expansions in cup volumes in favor of the patients for right and left eyes (0.15 ± .0.19 vs 0.05 ± 0.05, P = 0.03 and 0.17 ± 0.14 vs 0.05 ± 0.05, P = 0.001, respectively). The only significant difference between the left and right eyes of the migraineurs was the RNFL thickness in the superior quadrant. Ganglion cell layer thickness did not differ between the right eyes, left eyes and controls. In conclusion, children with migraine showed significant variations in specific RNFL and optic disc parameters compared to control subjects.
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10
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Andreou AP, Edvinsson L. Mechanisms of migraine as a chronic evolutive condition. J Headache Pain 2019; 20:117. [PMID: 31870279 PMCID: PMC6929435 DOI: 10.1186/s10194-019-1066-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/03/2019] [Indexed: 12/17/2022] Open
Abstract
Understanding the mechanisms of migraine remains challenging as migraine is not a static disorder, and even in its episodic form migraine remains an "evolutive" chronic condition. Considerable progress has been made in elucidating the pathophysiological mechanisms of migraine, associated genetic factors that may influence susceptibility to the disease, and functional and anatomical changes during the progression of a migraine attack or the transformation of episodic to chronic migraine. Migraine is a life span neurological disorder that follows an evolutive age-dependent change in its prevalence and even clinical presentations. As a disorder, migraine involves recurrent intense head pain and associated unpleasant symptoms. Migraine attacks evolve over different phases with specific neural mechanisms and symptoms being involved during each phase. In some patients, migraine can be transformed into a chronic form with daily or almost daily headaches. The mechanisms behind this evolutive process remain unknown, but genetic and epigenetic factors, inflammatory processes and central sensitization may play an important role.
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Affiliation(s)
- Anna P Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- The Headache Centre, Guy's and St Thomas', NHS Foundation Trust, London, UK.
| | - Lars Edvinsson
- Department of Medicine, Lund University, 22185, Lund, Sweden
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Raucci U, Della Vecchia N, Ossella C, Paolino MC, Villa MP, Reale A, Parisi P. Management of Childhood Headache in the Emergency Department. Review of the Literature. Front Neurol 2019; 10:886. [PMID: 31507509 PMCID: PMC6716213 DOI: 10.3389/fneur.2019.00886] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/30/2019] [Indexed: 12/16/2022] Open
Abstract
Headache is the third cause of visits to pediatric emergency departments (ED). According to a systematic review, headaches in children evaluated in the ED are primarily due to benign conditions that tend to be self-limiting or resolve with appropriate pharmacological treatment. The more frequent causes of non-traumatic headache in the ED include primitive headaches (21.8–66.3%) and benign secondary headaches (35.4–63.2%), whereas potentially life-threatening (LT) secondary headaches are less frequent (2–15.3%). Worrying conditions include brain tumors, central nervous system infections, dysfunction of ventriculo-peritoneal shunts, hydrocephalus, idiopathic intracranial hypertension, and intracranial hemorrhage. In the emergency setting, the main goal is to intercept potentially LT conditions that require immediate medical attention. The initial assessment begins with an in-depth, appropriate history followed by a complete, oriented physical and neurological examination. The literature describes the following red flags requiring further investigation (for example neuroimaging) for recognition of LT conditions: abnormal neurological examination; atypical presentation of headaches: subjective vertigo, intractable vomiting or headaches that wake the child from sleep; recent and progressive severe headache (<6 months); age of the child <6 years; no family history for migraine or primary headache; occipital headache; change of headache; new headache in an immunocompromised child; first or worst headache; symptoms and signs of systemic disease; headaches associated with changes in mental status or focal neurological disorders. In evaluating a child or adolescent who is being treated for headache, physicians should consider using appropriate diagnostic tests. Diagnostic tests are varied, and include routine laboratory analysis, cerebral spinal fluid examination, electroencephalography, and computerized tomography or magnetic resonance neuroimaging. The management of headache in the ED depends on the patient's general conditions and the presumable cause of the headache. There are few randomized, controlled trials on pharmacological treatment of headache in the pediatric population. Only ibuprofen and sumatriptan are significantly more effective than placebo in determining headache relief.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicoletta Della Vecchia
- Department of Pediatrics, University of "Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Chiara Ossella
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Chiara Paolino
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
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Abstract
Primary headaches are one of the most prevalent neurological disorders and can occur during a wide range of lifespan. Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack. There is no systematic review of whether these symptoms changes during lifespan. Indeed, the clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in contrast, largely an absence of autonomic signs and a more often bilateral headache in the elderly. The age-dependent differences in the clinical presentation are less distinct in cluster headache and, especially, in tension-type headache. The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.
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Affiliation(s)
- Andreas Straube
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-University, 81377, Munich, Germany.
| | - Anna Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,The Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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13
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Mackay MT, Lee M, Yock-Corrales A, Churilov L, Donnan GA, Monagle P, Babl FE. Differentiating arterial ischaemic stroke from migraine in the paediatric emergency department. Dev Med Child Neurol 2018; 60:1117-1122. [PMID: 29655223 DOI: 10.1111/dmcn.13772] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 01/03/2023]
Abstract
AIM To estimate the strengths of association between clinical features and migraine or arterial ischaemic stroke (AIS) in children presenting to the emergency department. METHOD Eighty-four children with migraine, prospectively recruited from 2009 to 2010, were compared with 55 children with AIS, prospectively/retrospectively recruited from 2003 to 2010. Odds ratios were calculated via logistic regression to measure associations between clinical features and process-of-care factors, and migraine and AIS. RESULTS Median age was 13 years 5 months (interquartile range 12y 11mo-13y 10mo) for migraine and 5 years (interquartile range 3y 7mo-8y) for patients with AIS. All cases of AIS and 30% of migraine cases underwent neuroimaging. Over 40% of children with migraine had vomiting, numbness, or visual disturbance; other symptoms were uncommon. Fifty-five per cent had no signs on physician assessment. Weakness or speech disturbance were common in patients with AIS. Significant clinical features associated with increased odds of AIS included sudden symptom onset, weakness, seizures, speech disturbance, and ataxia, and signs of face, arm, or leg weakness, inability to walk, dysarthria, dysphasia, and altered consciousness (p<0.05). Significant features associated with decreased odds of AIS included older age, vomiting, visual, sensory, other symptoms, and absent focal signs on assessment (p<0.05). INTERPRETATION Presenting features can discriminate childhood AIS from migraine. These differences inform decisions about urgency and type of neuroimaging in children presenting to the emergency department with brain attack symptoms. WHAT THE PAPER ADDS Weakness, seizures, ataxia, speech, or walking difficulties are more frequent in arterial ischaemic stroke (AIS). Vomiting, visual, or sensory disturbance and absent focal signs are more frequent in migraine. Identifying features of AIS and migraine guides neuroimaging in children with brain attack symptoms.
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Affiliation(s)
- Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Parkville, Vic., Australia.,Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,Florey Institute of Neurosciences and Mental Health, Parkville, Vic., Australia
| | - Michelle Lee
- Emergency Department, Royal Children's Hospital Melbourne, Parkville, Vic., Australia
| | | | - Leonid Churilov
- University of Melbourne, Parkville, Vic., Australia.,Florey Institute of Neurosciences and Mental Health, Parkville, Vic., Australia
| | - Geoffrey A Donnan
- University of Melbourne, Parkville, Vic., Australia.,Florey Institute of Neurosciences and Mental Health, Parkville, Vic., Australia
| | - Paul Monagle
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,Department of Haematology, Royal Children's Hospital, Parkville, Vic., Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,Emergency Department, Royal Children's Hospital Melbourne, Parkville, Vic., Australia
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14
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Kang BS, Lee J, Choi JH, Kwon HH, Kang JW. Clinical manifestations of headache in children younger than 7 years. KOREAN JOURNAL OF PEDIATRICS 2018; 61:355-361. [PMID: 30304907 PMCID: PMC6258963 DOI: 10.3345/kjp.2018.06331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/16/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Headache is a common symptom during childhood. It is usually persistent and requires special care. This study aimed to identify the characteristics of headache in children <7 years of age. METHODS We reviewed 3 years of clinical files on children <7 years of age with a chief complaint of headache. RESULTS This study included 146 children (66 males, 80 females; mean age, 5.5±1.0 years). Mean symptom duration was 5.8±7.9 months. Attack durations were longer than 2 hours in 31 patients, shorter than 2 hours in 70 patients, and unchecked in 45 patients. Attack frequency was 15.1±10.6 times per month. Pain locations and characteristics were also variable. Mean pain severity score was 5.1±2.2 on the visual analog scale. Of 38 patients who underwent electroencephalography, 9 showed positive findings. Of 41 who underwent brain magnetic resonance imaging, 20 showed positive findings. The diagnoses were migraine (including probable migraine) in 34, tension-type headache in 5, and congenital malformations in 3. Medications were used in 29 patients: acetaminophen in 17, ibuprofen in 8, naproxen sodium in 1, and topiramate or amitriptyline in 3. CONCLUSION In children aged <7 years, headache has a relatively benign course, but detailed history taking is needed for more accurate diagnosis.
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Affiliation(s)
- Bu Seon Kang
- Department of Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jinsun Lee
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Hyuk Choi
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyeok Hee Kwon
- Department of Medical Science, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Joon Won Kang
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.,Department of Medical Science, College of Medicine, Chungnam National University, Daejeon, Korea.,Brain Research Institute, Chungnam National University School of Medicine, Daejeon, Korea
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15
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Strauss LD, Cavanaugh BA, Yun ES, Evans RW. Incidental Findings and Normal Anatomical Variants on Brain MRI in Children for Primary Headaches. Headache 2017; 57:1601-1609. [DOI: 10.1111/head.13221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Ethan SungEun Yun
- Department of Neurology; Wake Forest Baptist Health; Winston-Salem NC USA
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16
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Yoo IH, Kim W, Kim H, Lim BC, Hwang H, Chae JH, Choi J, Kim KJ. Factors Associated with Favorable Outcome of Topiramate Migraine Prophylaxis in Pediatric Patients. J Clin Neurol 2017; 13:281-286. [PMID: 28748680 PMCID: PMC5532325 DOI: 10.3988/jcn.2017.13.3.281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/18/2017] [Accepted: 03/20/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND PURPOSE There are few studies that have investigated predictive factors related to migraine prophylaxis of which produced inconsistent results. The aim of this study was to identify factors that can predict the treatment response to topiramate prophylaxis in pediatric patients with migraine. METHODS One hundred and thirteen patients who were older than 7 years and received topiramate for at least 3 months were recruited from the Seoul National University Bundang Hospital outpatient clinic from 2005 to 2014. A positive response was defined as a reduction of more than 50% in the number of migraine episodes after topiramate treatment. Proposed predictive factors such as migraine characteristics including severity and frequency were assessed, as were other data on sex, disease duration, associated symptoms, family history, and impairment of daily activities. RESULTS Seventy patients (61.9%) responded to prophylactic treatment with topiramate. Patients who experienced significant impairment in daily activities showed significant benefit from the treatment (p=0.004). Sex, the severity, frequency, and duration of migraine episodes, disease duration, treatment duration, age at onset, and associated symptoms were not significantly related to a response to topiramate treatment. CONCLUSIONS Migraine characteristics and associated symptoms were not significantly related to a response to topiramate treatment. However, patients with significant impairment in daily activities showed significant benefit from the treatment, and so prophylactic topiramate treatment should be strongly encouraged in this patient group.
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Affiliation(s)
- Il Han Yoo
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - WooJoong Kim
- Pediatric Clinical Neuroscience Center, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Byung Chan Lim
- Pediatric Clinical Neuroscience Center, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Hee Chae
- Pediatric Clinical Neuroscience Center, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Jieun Choi
- Department of Pediatrics, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Ki Joong Kim
- Pediatric Clinical Neuroscience Center, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
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17
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Genizi J, Khourieh Matar A, Zelnik N, Schertz M, Srugo I. Frequency of pediatric migraine with aura in a clinic-based sample. Headache 2015; 56:113-7. [PMID: 26790850 DOI: 10.1111/head.12741] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the prevalence and risk factors for pediatric migraine with aura (MWA) among patients presenting to pediatric neurology clinics. BACKGROUND Headache is a common complaint among children, and the prevalence of migraine is about 8%. Up to one third of adults with migraine report experiencing aura; however, the exact percentage in children is unknown. METHODS Medical records of children presenting with headache to three pediatric neurology clinics in Haifa in the last 5 years were retrospectively reviewed. Inclusion criteria were a diagnosis of migraine headache at 5-18 years of age. RESULTS Of 260 children (140 female) who had migraine, 26.2% experienced aura. MWA was more common among females compared to males (32.6% vs 18.9%, P < .01) and among older children (OR: 2.50, 95% CI: 1.20-5.20; P < .01). Among those who experienced aura, visual aura was more common in females than males (66.7% vs 33.3%, P < .04). Family history of migraine was strongly related to MWA (P < .02): the odds of MWA were 2.46 times greater in children who had a family history of migraine. (OR: 2.46, 95% CI: 1.08-5.62; P < .03). CONCLUSIONS MWA is as common in children as in adults. Aura is more common in older children. Children who have MWA are more likely to have a family history of migraine.
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Affiliation(s)
- Jacob Genizi
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel.,Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Nathanel Zelnik
- Pediatric Neurology Unit, Carmel Medical Center, Haifa, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mitchell Schertz
- Child Development & Pediatric Neurology Service, Meuhedet - Northern Region, Haifa, Israel
| | - Isaac Srugo
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
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18
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Raieli V, Pitino R, Giordano G, Spitalieri C, Consolo F, Puma D, Santangelo G, Vanadia F, D'Amelio M. Migraine in a pediatric population: a clinical study in children younger than 7 years of age. Dev Med Child Neurol 2015; 57:585-8. [PMID: 25586426 DOI: 10.1111/dmcn.12679] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 01/17/2023]
Abstract
AIM Migraines in children younger than 7 years of age have received limited attention in the published literature. The aim of this study is to describe the characteristics of migraine phenotypes in children younger than 7 years, and to compare them with migraines in children older than 7 years of age. METHOD We reviewed all standard clinical files, collected over 4 years, related to children with a diagnosis of primary headache. We included all children younger than 7 years diagnosed with migraine in our study. RESULTS A total of 374 children (188 males, 186 females) were affected by migraine with/without aura: 40 of these patients (10.7%; 20 males, 20 females; mean age 5y 7mo, SD 1y 2mo) where younger than 7 years old. The frequencies of the main migraine features in the younger age group were similar to those of children older than 7 years, with the exception of a shorter duration of migraine and reduced frequency of attacks. INTERPRETATION In children younger than 7 years of age, the clinical phenotype of migraine is similar to that seen in older children. We propose that there is a general genetic migraine susceptibility that, in the presence of activating environmental factors, may induce typical attacks of migraine in individuals already predisposed to migraine attacks. Therefore, different modules induce different clinical features within the different age groups, but there is no difference in the frequencies of clinical phenotypes between the two age groups.
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Affiliation(s)
- Vincenzo Raieli
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Renata Pitino
- Child Neuropsychiatry School, University of Palermo, Palermo, Italy
| | | | | | - Flavia Consolo
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Domenico Puma
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Giuseppe Santangelo
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Francesca Vanadia
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Marco D'Amelio
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
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19
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Abstract
The interaction between sleep and headache or migraine is powerful and an elevated comorbidity between these 2 disorders has been reported in either adults or children. This comobidity is linked to common neurophysiological and neuroanatomical substrates that are genetically based strongly. The first reports on this relationship were related to the prevalence of parasomnias and sleep-disordered breathing in headache but recent research has expanded the comorbidity to several other sleep disorders, such as restless legs syndrome, periodic limb movements during sleep, and narcolepsy. The assessment of children with headache should always include an accurate anamnesis for the presence of sleep problems either in the child or in the relatives; no correct approach for treating children and adolescents is possible without an integrated method of evaluation and management.
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Affiliation(s)
- Claudia Dosi
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Mariagrazia Figura
- Department of Clinical and Experimental Medicine University of Messina, Messina, Italy; Oasi Research Insitute IRCCS, Troina, Italy
| | | | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy.
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20
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Abstract
Migraine is commonly associated with nausea and vomiting, though, interestingly, vomiting has also been reported by some patients to be therapeutic, and may actually stop a migraine attack. In this review, we will first discuss the epidemiology of nausea and vomiting in migraine. Further, we will briefly review the connections between the enteric nervous system, the autonomic nervous system, and the central nervous system as they pertain to understanding the question of "Why does vomiting stop a migraine attack?"
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21
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Kóbor J, Nyári T, Benedek G, Túri S. Age-related prevalence and features of migraine headache in Hungarian schoolchildren and adolescents. Eur J Paediatr Neurol 2013; 17:600-7. [PMID: 23746927 DOI: 10.1016/j.ejpn.2013.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 05/05/2013] [Accepted: 05/09/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Differences occur in certain features of childhood and adult migraine, such as the duration and location. However, few studies have been reported of the changes in other symptoms during childhood. AIMS The aims of this study were to establish the prevalence of migraine headache in children in Hungary, and to investigate the changes in prevalence of migraine and migraine symptoms in a wide paediatric age range. METHODS We conducted a school-based study with the use of a questionnaire. RESULTS 7361 7-18-year-old students participated. The 1-year prevalence of migraine was 12.5% (9.2% in boys and 15.4% in girls). With the criterion of a headache duration of 4 h for 15-18-year-olds and of 1 h below the age of 15, the overall prevalence decreased to 9.1%. The prevalence of migraine increased steadily from young childhood to late adolescence in both boys and girls. The frequency and duration of headache increased, whereas vomiting and nausea became less prevalent with advancing age in both genders. The prevalence of uni/bilaterality, photophobia and phonophobia increased only in girls, while that of a pulsating character did so only in boys. CONCLUSIONS The migraine characteristics displayed by the studied population proved similar to those experienced in other countries. The duration of headache applied in the diagnosis of migraine exerts a great impact on the prevalence data. The features of migraine change with advancing age, a situation demanding consideration in studies on migraine in children of different ages.
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Affiliation(s)
- Jenő Kóbor
- Department of Paediatrics, Faculty of Medicine, University of Szeged, Szeged, Hungary.
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22
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Ramdas S, Prasad M, Abu-Arafeh I. Primary headache disorders in children under 7 years of age. Scott Med J 2013; 58:26-9. [DOI: 10.1177/0036933012474591] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and aim Research on headache disorders in young children is limited. This study aims to determine causes and clinical presentations of headache in young children attending a specialist clinic. Methods and results All children attending the headache clinic over 9-year period were included. Data were collected prospectively on demography and clinical presentations of headache at every attendance. The diagnosis of headache disorders was based on the International Classification of Headache Disorders-II (2004). Of the 921 children (491 male) who attended the clinic, 73 children (8%) were under 7 years of age at presentation; 34 children had migraine, 11 had tension-type headache (4 chronic), 4 had mixed types of headache and 16 children had unclassified headaches. Anorexia, nausea, vomiting, light intolerance and noise intolerance were common during migraine attacks and forehead was the most common site of maximal pain. Conclusions Migraine is the most common headache disorder in young children attending a specialist clinic. Headache presentation is often atypical and in 20% of young children headache disorders are unclassified. Chronic tension-type headache, often considered a disease of adolescents and adults, is shown to present in early age.
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Affiliation(s)
- S Ramdas
- Paediatric Registrar, Stirling Royal Infirmary, UK
| | - M Prasad
- Registrar in Paediatric Neurology, Stirling Royal Infirmary, UK
| | - I Abu-Arafeh
- Consultant Paediatrician, Stirling Royal Infirmary, UK
- Headache Clinic, Fraser of Allander Neurosciences Unit, Royal Hospital for Sick Children, UK
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23
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Colombo B, Dalla Libera D, De Feo D, Pavan G, Annovazzi PO, Comi G. Delayed diagnosis in pediatric headache: an outpatient Italian survey. Headache 2012; 51:1267-73. [PMID: 21884081 DOI: 10.1111/j.1526-4610.2011.01976.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this prospective study is to assess the time lapse between the onset of recurring headache and the correct diagnosis in a cohort of pediatric patients attending an Italian children's headache center for the first time. METHODS One hundred and one patients and parents, referred to the Pediatric Headache Centre of San Raffaele Hospital in Milan, Italy, underwent a semi-structured interview to ascertain features of headache since onset (clinical and family history, presence of childhood periodic syndromes, previously undergone instrumental exams and specialists' examinations before the correct diagnosis, past and current treatment). All patients were evaluated by expert neurologists and their headache was classified according to the International Classification of Headache Disorders II (2004). RESULTS The median time delay from the onset of the first episode of recurrent headache to definite diagnosis was 20 months (interquartile range 12 to 36 months). A correlation with younger age and a more delayed headache diagnosis was found (r Spearman = 0.25; P = .039). An association between diagnostic delay and positive family history (median 24 months [12 to 48] vs 12 [6 to 24]; P = .014) or female gender (median 18 months [12 to 42] vs. 12 [5 to 30]; P trend = .070) was also evident. Notably, 76 out of 101 patients referred to our Center received an appropriate diagnosis according to International Classification of Headache Disorders II at the time of our visit only. Of note, up to 21% of this group were previously misdiagnosed (for epilepsy 43%, sinusitis 38%, or other diseases 19%), a fact that contributed to a longer time of clinical assessment (median 39 months) before reaching a correct diagnosis. The other group of 80 patients (79%) did not receive a specific diagnosis and treatment, and were not studied until their symptom became chronic and disabling. CONCLUSION Pediatric headache is still under-diagnosed and not adequately considered as a health problem in the medical community as well as social settings. There is a need for educational programs regarding headache involving not only general practitioners, pediatricians, and neurologists, but also the general population. These are desirable in order to raise awareness of such a condition and, accordingly, treat children accurately.
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Affiliation(s)
- Bruno Colombo
- Department of Neurology, Headache Center, INSPE, San Raffaele Hospital Scientific Institute, Vita-Salute University, Milano, Italy
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24
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Özge A, Termine C, Antonaci F, Natriashvili S, Guidetti V, Wöber-Bingöl Ç. Overview of diagnosis and management of paediatric headache. Part I: diagnosis. J Headache Pain 2011; 12:13-23. [PMID: 21359874 PMCID: PMC3056001 DOI: 10.1007/s10194-011-0297-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 11/25/2010] [Indexed: 11/05/2022] Open
Abstract
Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. Moreover, the possible role of psychological factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. Subjects who have any signs or symptoms of focal/progressive neurological disturbances should be investigated by neuroimaging techniques. The electroencephalogram and other neurophysiological examinations are of limited value in the routine evaluation of headaches. In a primary headache disorder, headache itself is the illness and headache is not attributed to any other disorder (e.g. migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalgias). In secondary headache disorders, headache is the symptom of identifiable structural, metabolic or other abnormality. Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated with severe vomiting and headache associated with straining. Thus, the differential diagnosis between primary and secondary headaches rests mainly on clinical criteria. A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment, bearing in mind that children with headache are more likely to experience psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms and this creates an important healthcare problem for their future life.
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Affiliation(s)
- Aynur Özge
- Department of Neurology, Mersin University School of Medicine, Mersin, Turkey
| | - Cristiano Termine
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Fabio Antonaci
- University Center for Adaptive Disorders and Headache (UCADH), Unit of Pavia, Pavia, Italy
| | - Sophia Natriashvili
- Department of Psychiatry of Childhood and Adolescence, Medical University of Vienna, Vienna, Austria
| | - Vincenzo Guidetti
- Department of Child and Adolescent Neuropsychiatry, University La Sapienza, Rome, Italy
| | - Çiçek Wöber-Bingöl
- Department of Psychiatry of Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
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25
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Milde-Busch A, Boneberger A, Heinrich S, Thomas S, Kühnlein A, Radon K, Straube A, von Kries R. Higher prevalence of psychopathological symptoms in adolescents with headache. A population-based cross-sectional study. Headache 2010; 50:738-48. [PMID: 20100300 DOI: 10.1111/j.1526-4610.2009.01605.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Headache is commonly voiced by adolescents and is known to be associated with reduced quality of life. Otherwise, there are only limited data regarding associations between different types of headache and psychopathological symptoms in adolescents. OBJECTIVES Aim of the present study in adolescents was to assess the impact of headache on psychopathological symptoms and whether these differ between types of headache. METHODS Data were derived from a population-based sample (n = 1047, ages 13-17 years). Type of headache (ie, migraine, tension-type headache, miscellaneous headache) was ascertained for subjects reporting headache episodes at least once per month. Psychopathological symptoms were assessed with the Strengths and Difficulties Questionnaire. The following dimensions were taken into account: emotional symptoms, conduct problems, hyperactivity/inattention, peer problems (these 4 add to the total difficulties score), and prosocial behavior. Associations were estimated with logistic regression models with adjustment for age group, sex, and family situation. RESULTS Headache at least once per month was reported by 47.8% of the adolescents. Subjects with any headache were found to be at higher risk for emotional symptoms (odds ratio 1.5; 95% confidence interval 1.0-2.2) and hyperactivity/inattention (1.4; 1.0-1.9), resulting in a higher total difficulties score (1.6; 1.1-2.4). While the risk for psychopathological symptoms was not significantly increased in subjects with tension-type headache compared with subjects without headache, significant associations with emotional symptoms were found in subjects with migraine (2.9; 1.3-6.2; total difficulties score: 3.1; 1.4-6.8). Miscellaneous headache was associated with a broad spectrum of psychopathological symptoms: emotional symptoms (1.8; 1.0-3.3), conduct problems (1.6; 1.0-2.6), hyperactivity/inattention (1.9; 1.2-3.1), total difficulties score (2.7; 1.6-5.6). CONCLUSION Previously reported associations between headache and psychopathological symptoms in adolescents could be confirmed, but might vary with type of headache. As psychopathological symptoms may be a precursor for manifest psychiatric disorders, adolescents particularly with migraine and miscellaneous headache appear to be a vulnerable population.
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Affiliation(s)
- Astrid Milde-Busch
- From the Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University, Munich, Germany
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