Headache

Chapter 15 Headache



Jane F. Knapp, MD, Robert D. Schremmer, MD



1 Do children get migraine headaches?


Migraine is one of the most common causes of headache in children. The reported prevalence is 3–10%. The variation in prevalence between studies is due primarily to differences in diagnostic criteria used and the age range of children studied. Of children referred to pediatric neurologists for the evaluation of headache, migraine is diagnosed in 75%.



2 Are the international headache society (IHS) criteria for the diagnosis of migraine headache applicable to children?


The IHS criteria were developed primarily for the diagnosis of headache in adults. The second edition of the International Classification of Headache Disorders (ICHD-2), published in 2004, reduces the duration requirements of the headache from 4–72 hours in adults to 1–72 hours in children under age 15 years. It also acknowledges that photophobia and phonophobia must be inferred from behavior in young children. The IHS guidelines do not account for other possible symptomatic differences, including intensity and location of pain. Pediatric migraines are often bilateral. A higher incidence of photophobia or phonophobia alone also occurs, especially in younger children.



3 List the criteria for pediatric migraine without aura.




A At least five attacks fulfilling criteria listed for B–D


B Duration of 1–48 hours


C Headache with at least two of the following:


image Bilateral (frontal/temporal) or unilateral location

image Pulsatile quality

image Headache intensity moderate or severe

image Aggravation by routine physical activity

D During headache, at least one of the following occurs:


image Nausea and/or vomiting

image Photophobia and/or phonophobia

Maytal J, Young M, Shechter A, Lipton RB: Pediatric migraine and the International Headache Society criteria. Neurology 48:602–607, 1997.


Winner P, Wasiewski W, Gladstein J, et al: Multicenter prospective evaluation of proposed pediatric migraine revisions to the IHS criteria. Headache 37:545–548, 1997.



4 List the criteria for pediatric migraine headache with aura.




A At least two attacks fulfilling criteria listed for B


B At least two of the following:


image One or more fully reversible aura symptoms, including focal cortical and/or brain stem dysfunction

image At least one aura developing gradually over more than 4 minutes, or two or more symptoms occurring in succession

image Headache follows less than 60 minutes after aura symptoms


5 List some common triggers for migraine in children.


Stress, fatigue (including lack of sleep), hunger, glare, head trauma, and certain foods containing nitrates, caffeine, tyramine, glutamate, or salt are common triggers. Eye strain, cold foods, and high altitude are less common.



6 Do children get tension-type headaches?


The prevalence of tension-type headaches in children and adolescents ranges from 10% to 25%, but one study reported a prevalence of 73% in Brazilian children and adolescents age 10–18 years. The ICHD-2 lists three subtypes of tension-type headaches: (1) infrequent episodic (headaches on <1 day per month), (2) frequent episodic (headaches on 1–14 days per month), and (3) chronic (headaches on ≥15 days per month). These headaches are characterized by mild to moderate pressing or tightening pain that is nonpulsatile. The pain is usually bilateral and not aggravated by routine activity. Nausea and vomiting do not occur, but phonophobia or photophobia may be present. Clinical features are the same in children and adults.


Anttila P: Tension-type headache in children and adolescents. Curr Pain Headache Rep 8:500–504, 2004.



7 Are causes of tension-type headaches the same for adults and children?


Pediatric tension-type headaches probably share some risk factors, but there are some differences. Analgesic overuse, psychosocial stress, psychiatric disorders, muscular tension, and oromandibular dysfunction are potential causes of tension-type headaches in adults. Analgesic overuse has not been found in children. Psychosocial stress (divorced parents, physical changes during adolescence, difficulty with peer relations, and chronic illness) are more often reported in children with tension-type headaches. Also, children with frequent episodic tension-type headaches more commonly manifest depressive symptoms. The presence of scoliosis may also precipitate tension-type headaches in some children.



8 Can children suffer from both migraines and tension-type headaches?


Although the ICHD-2 does not recognize a separate category of mixed migraine and tension-type headache, characteristics of both types of headache may be found in many children. In one Canadian study, one third of the patients with migraine symptoms fulfilled the IHS criteria of tension-type headaches as well. Some researchers have postulated that episodic tension-type headache and migraine may fall along the same continuum of disorder.


Sarioglu B, Erhan E, Serdaroglu G, et al: Tension-type headache in children: A clinical evaluation. Pediatr Int 45:186–189, 2003.


Seshia SS: Mixed migraine and tension-type: A common cause of recurrent headache in children. Can J Neurol Sci 31:315–318, 2004.

Related posts:

Fever Shock Syncope Respiratory Failure Anaphylaxis Respiratory Emergencies

Stay updated, free articles. Join our Telegram channel
Tags:
Sep 1, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Headache

Full access? Get Clinical Tree
Get Clinical Tree app for offline access