Headache In Pediatric Patients Research Articles

Analysis of headache in children's patients, its relationship with chronic rhinosinusitis at the sanatorium-resort stage of treatment

To determine the structure and nature of headache in pediatric patients, as well as its relationship with chronic rhinosinusitis, to develop an effective rehabilitation course for pediatric patients with headache at the sanatorium-resort stage. The study included 100 patients aged 8 to 17 years who received a course of sanatorium treatment. Patients were divided into groups: with primary headache and with secondary headache in chronic rhinosinusitis. The results of a comprehensive otorhinolaryngological and neurological study made it possible to determine the mechanism of development, structure, and nature of the predominant types of headache in children and to develop a course of rehabilitation treatment. An analysis of the effectiveness of the rehabilitation course showed that it was possible to achieve a positive result in 88% of children with primary and secondary headache. The necessity of interdisciplinary participation of otorhinolaryngologists and neurologists in the examination and treatment of patients complaining of headache at the sanatorium-resort stage is substantiated. The effectiveness of the proposed rehabilitation course of headache treatment of various origins in children has been proven, the analysis of long-term results allows us to recommend it during staged therapy.

Cephalgic Syndrome Correction in Pediatric Patients at the Sanatorium Treatment Stage: a Simple Randomized Prospective Study

INTRODUCTION. Diagnosis and treatment of headache in pediatric patients is of priority medical and social importance, including when correcting it at the sanatorium and health resort stage. Difficulties and problems are associated with the complexity of taking an anamnesis in children, incorrect diagnosis, comorbidity, the need for timely correction of risk factors, and the appointment of the effective pathogenetically proved treatment. AIM. To determine the structure and features of the cephalgic syndrome in pediatric patients undergoing treatment in Evpatoria sanatoriums and to determine the effectiveness of psychological correction in the treatment of patients with frequent tension-type headache by using the method of music therapy method. MATERIAL AND METHODS. As a result of a complex examination of pediatric patients, 150 patients with headache complaints were selected out of 513 examined by the method of simple random sampling. Together with a psychologist, a subgroup of 30 patients with frequent tension headaches was selected from the total number of patients after psychological testing for whom music therapy was included in the treatment plan. RESULTS AND DISCUSSION. In the structure of the cephalgic syndrome the prevalence of tension headache was revealed, while 20% of patients had frequent episodic tension headache against the background of increased anxiety and fatigability, which significantly affects quality of life and social functioning. The patients who underwent correction of tension headaches by music therapy showed improvement of extraversion indices, reduction of neuroticism, decrease of anxiety, fatigability and irritability indices, decrease of frequencyand intensity of headaches. None of the patients were diagnosed with headache according to ICHD-III in the referral diagnosis for sanatorium treatment, but were diagnosed with vegetative-vascular dystonia and other comorbidities. CONCLUSION. The obtained data of a complex examination made it possible to substantiate a pathogenetically differentiated rehabilitation course in sanatorium treatment and led to an increase in the efficiency and quality of treatment for each patient. Using the method of music therapy, emotional and psychological correction was carried out, which occupies an important place in the relief of headache in pediatric patients.

Cosyntropin for the Treatment of Refractory Postdural Puncture Headache in Pediatric Patients: A Retrospective Review.

Postdural puncture headache is a challenging complication of diagnostic, therapeutic, and unintentional lumbar puncture. Literature evidence supports cosyntropin as a viable noninvasive therapy for adults who have failed conservative management, but pediatric data are limited. The purpose of this retrospective chart review was to describe the use of intravenous cosyntropin for refractory pediatric postdural puncture headache at a single free-standing tertiary care pediatric hospital. Patients who had received cosyntropin were identified. Charts were retrospectively reviewed for indication, dosing information, efficacy, and side effects. The response was defined as a 50% reduction in pain score, with a secondary efficacy measure of time to discharge after the first dose. Over a 5-year period, 26 patients received 37 doses of cosyntropin. Dosing ranged from 5 to 15 mcg/kg (median, 10.4 mcg/kg). There was a significant reduction in pain scores after the first dose of cosyntropin (P=0.008). Eighty-one percent of patients (n=21) achieved either a 50% reduction in pain or were discharged within 24 hours after the first dose. The median time to 50% pain reduction in 13 patients who achieved it before or discharge was 5 hours (range, 1 to 30 h). The median time to discharge after the first dose was 20 hours (range, 2 to 72 h). Ten patients received >1 dose of cosyntropin. Three patients required an epidural blood patch. No adverse effects related to treatment were identified. This study suggests that while further research is warranted, cosyntropin is a potential alternative to epidural blood patch for pediatric patients with postdural puncture headache who fail conservative management.

Prophylaxis with melatonin for primary stabbing headache in pediatrics: a case report

Introduction: Primary stabbing headache (or “ice pick headache”) is an alteration characterized by brief jabs (short stabs of pain, lasting ~3 seconds), which appear spontaneously, irregularly, and affecting unilaterally or bilaterally. Indomethacin has traditionally been used as the main therapeutic option. However, this drug is ineffective in a considerable percentage of patients and can generate multiple adverse effects that occur at therapeutic doses. Clinical case: A 7-year-old male patient with primary stabbing headache of mild to moderate intensity, lasting 3 to 4 seconds, without relevant history, with normal neurodevelopment, neurological examination and neuroimaging; no triggers were identified. It was started therapeutic trial with Coenzyme Q10; however, no improvement in the symptoms was identified. Treatment and outcomes: A therapeutic management was carried out with Melatonin, which led to complete remission of the symptoms; without adverse effects in the posterior follow-up months. Clinical and scientific relevance: There is little information regarding effective and safe treatments for primary stabbing headache in children. The present case identifies Melatonin as an innovative, effective and safe therapeutic alternative in the treatment of primary stabbing headache in children. This is a significant advance in the understanding of primary stabbing headache in the pediatric population. Conclusion: Melatonin may be an effective and safe therapeutic option for the treatment of primary stabbing headache in pediatric patients. It is necessary to deepen its research, in order to establish its use in a clinical practice guide.

Primary Headache and Rheumatic Disease

Investigators at Istanbul University and Mersin University School of Medicine, Turkey, assessed the occurrence, prevalence and clinical characteristics of primary headache in pediatric patients, aged <16 years, with chronic rheumatic diseases such as juvenile idiopathic arthritis (JIA) and familial Mediterranean fever (FMF).

A randomized trial comparing amitriptyline versus topiramate for the prophylaxis of chronic daily headache in pediatric patients

Objective: the goal of this prospective and double-blind study was to compare the efficacy of amitriptyline and topiramate for the prevention of pediatric chronic daily headache (CDH). Research design and methods: fifty-seven children (aged 9−16 yr) diagnosed with CDH were randomly assigned to two groups: group A (n = 29 patients) received amitriptyline 0.5 mg/kg/d and group B (n = 28 patients) received topiramate 25 mg/d increasing up to 100 mg/d according to patient response. Treatment response was monitored for at least 4 months. Results: fifty-five percent of the patients in group A responded to amitriptyline and 61% of patients in group B responded to topiramate as defined by a reduction of more than 50% in monthly headache frequency. There was no significant difference in responder rate or adverse event rate between the two groups (p > 0.05). By the end of the 4-month treatment period, there were no significant differences in the final average severity and monthly frequency of headaches between treatment groups. Conclusion: these results suggest that the efficacy and tolerability of topiramate is equivalent to that of amitriptyline for reducing the frequency of headache in pediatric CHD patients.

Headache in Pediatric Patients With Celiac Disease and Its Prevalence as a Diagnostic Clue

Headache in Pediatric Patients With Celiac Disease and Its Prevalence as a Diagnostic Clue

Profile of Children with Migraine

To assess the clinical characteristics of patients with migraine. The medical records of 76 patients diagnosed with migraine were reviewed using the ICHD-II 2004 diagnosis criteria. The patients were classified into three age groups: 3-6 yr olds (group I), 7-12 yr olds (group II), and 13-17 yr olds (group III). Migraine was the most common cause of headache in the patients of present pediatric neurology outpatient clinic (57.1%, 76/133). The mean age of patients was 11.08 ± 3.27 (3.25-17) yrs. The number of girls as the age increased (groups II and III). The mean headache attacks rate was 2.5 ± 1.5 per wk, which resulted in worsening of school performance (n = 26, 34.2%). In the majority of patients (n = 54, 71.1%), there was a family history of migraine or headache in the close relatives. Prophylaxis was found effective for all given medications (flunarizine: 46/54, propranolol: 19/21, topiramate: 10/10, sodium valproate: 1/1). These findings indicate that: (a) migraine is the most frequent cause of headache in pediatric patients, (b) it has negative effects on school performance and daily activities, (c) the family history is important for making the diagnosis and (d) prophylaxis is significantly effective.

Headache in Pediatric Patients With Celiac Disease and Its Prevalence as a Diagnostic Clue

To establish the prevalence of headache in children with celiac disease (CD), the response to a gluten-free diet, and the prevalence of CD in children affected by headache. This hospital-based study included 2 steps. In the retrospective part, 354 children with CD answered a questionnaire investigating the presence of headache before and after the gluten-free diet. The same questionnaire was administered to 200 healthy children matched for sex and age. In the prospective part, 79 children affected by headache were screened for CD by antitransglutaminase IgA. Diagnosis of CD was confirmed by duodenal biopsy; before starting a gluten-free diet patients underwent a brain positron emission tomography study. After 6 months of follow-up children were reevaluated for the presence of headache. Overall, 88 patients with CD complained of headaches before the diagnosis of CD as compared with 16 in the control group (24.8% vs 8%, P < 0.001). After the institution of a gluten-free diet, the headaches significantly improved in 68 children (77.3%), of whom 24 (27.3%) were headache-free during the study period. Four of 79 (5%) headache patients were found to have CD compared with 0.6% of the general population (P = 0.005). The brain positron emission tomography studies did not show any anomalies. During the follow-up, headaches improved in all 4 children with CD. We recorded -- in our geographical area -- a high frequency of headaches in patients with CD and vice versa with a beneficial effect of a gluten-free diet. Screening for CD could be advised in the diagnostic work-up of patients with headache.

Headache in Pediatric Patients

Dr. Gladstein is Associate Professor of Pediatrics and Neurology, University of Maryland School of Medicine, and Director, Pediatric Headache Clinic and Pediatric Hospitalist Program, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201; E-mail: [email protected]. The author has disclosed that he is/was a member of the speakers bureaus of GlaxoSmithKline and Pfizer, Inc. The author also has disclosed that the use of triptans in the treatment of pediatric migraine as discussed in this article has not been approved by the U.S. Food and Drug Adminisration. Lippincott CME Institute, Inc., has identified and resolved all faculty conflicts of interest regarding this educational activity.

Epilepsy and Migraine Headache: Is There a Connection?

Introduction This study investigated the prevalence of migraine headache in pediatric patients with epilepsy and the incidence of these two disorders in the family history. Method A retrospective chart review was conducted on 475 patients with a primary diagnosis of epilepsy between January 2003 and June 2004. The patients were managed in a pediatric neurology outpatient clinic at a major teaching hospital. Cases were selected using the ICD-9-CM definition for epilepsy. Data collected included age, sex, headache, migraine, and family history. Results The study revealed a higher prevalence of migraine in epilepsy patients (14.7%) than in the general population (2.7% to 11%). Only 4.7% had a family history of migraine, but 20.6% had a positive family history of epilepsy, supporting current ideas of the genetic etiology of some epilepsies. Discussion This study specifically addressed epilepsy and migraine in children, but whenever a primary diagnosis is made, the potential for a coexisting disorder should be investigated.

Pupillary adrenergic sensitivity and idiopathic headache in pediatric patients.

Electronic pupillometry before and after phenylephrine eye drops was performed in 83 headache patients divided into two groups: Group A included 59 pediatric patients aged 5 to 16 years suffering from tension headache (TH = 8), common migraine (CM = 33) and classic migraine (CLM = 18); Group B comprised 24 adult patients aged 28 to 49 years suffering from CM. Comparisons were made with a group of healthy volunteer controls, 12 children and 15 adults, not suffering from headache. In Group A, only the CLM patients had significant mydriasis after phenylephrine; pupillary responses in the TH and CM cases did not differ significantly from the healthy controls, although there was an evident tendency for increased response in the CM by comparison with the TH cases. On the other hand, in Group B (adult CM) there was a significant pupillary hyper-responsiveness to adrenergic receptor stimulation, higher than in the same clinical condition in the pediatric group. In pre-pharmacological testing conditions, a significantly higher percentage of anisocoria (p less than 0.05) and a significant reduction in mean pupil size (p less than 0.01) were only evident in adult migraineurs as compared with controls. These findings suggest that a subtle chronic sympathetic deficiency affecting the iris neuromuscular junction in some clinical forms of primary headache may be detected by pupillometry at an early age. Moreover, apart from a temporal factor responsible for a progressive sympathetic imbalance during development, there may be a more evident neural transmission disorder in migraine forms as opposed to tension forms.