Experts’ opinion about the pediatric secondary headaches diagnostic criteria of the ICHD-3 beta

Özge, Aynur; Abu‐Arafeh, Ishaq; Gelfand, Amy A.; Goadsby, Peter J.; Cuvellier, Jean Christophe; Valeriani, Massimiliano; Сергеев, А. В.; Barlow, Karen M.; Uludüz, Derya; Yalın, Osman Özgür; Faedda, Noemi; Lipton, Richard B.; Rapoport, Alan M.; Guidetti, Vincenzo

doi:10.1186/s10194-017-0819-x

Cited by 27 publications

(30 citation statements)

References 85 publications

(77 reference statements)

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“…A recent study by Balestri et al underlined that classification of headache could be difficult considering duration criteria as a fundamental key [ 46 ], and Torriero et al reaffirmed this statement suggesting that the exclusion of headache duration criteria allowed a diagnosis of primary headache in more than 80% of children in their study [ 47 ]. Furthermore, Ozge and colleagues recently commented on the necessary distinction between pediatric and adult headache, emphasizing that specific subtopics of pediatric headache should be carefully defined and included in next ICHD criteria [ 48 ]. 3) All questionnaire-based studies have intrinsic limitations, related to recall and interpretation biases.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of headache in Italian adolescents aged 11–16 years: a cross-sectional questionnaire school-based study

Foiadelli¹,

Piccorossi²,

Sacchi³

et al. 2018

Ital J Pediatr

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BackgroundThe purpose of this study was to determine headache characteristics, impact on daily activities and medication attitudes among a large sample of adolescents in Italy.MethodsSecondary school classes were randomly selected from a national stratified multistage sampling. Data regarding socio-familial factors, headache characteristics, impact on daily activities and medication use were recorded with an anonymous multiple-choice questionnaire.ResultsThe survey involved 2064 adolescents. 1950 questionnaires were considered for analysis. Study population included 944 males (48.4%) and 1006 females (51.6%), aged between 11 and 16 years (mean 13.5 ± 1.87). Headache prevalence was 65.9%. Mean age at headache onset was 8.33 years. 9.8% suffered from headache > 1/week, 14.3% > 1/month, 24.2% monthly and 17.7% less than monthly. The mean duration of a headache episode was less than 30 min in 32.9%, 1 hour in 28.1%, 2 hours in 19.3% and several hours in 19.5%. Pain intensity was moderate in 52.2% and severe in 9.5%. School represented the main trigger factor (67%). Impact on daily activities was noted in 57.5%. 69.2% of adolescents reported the use of pain relievers. Up to 5.7% declared self-medication, while only 20.6% followed a physician’s prescription. Female adolescents experienced headache more frequently (70.2% vs 60%) and more intensely than male peers. Girls had a higher family history of headache, could more frequently identify a trigger factor, and were more affected into their daily activities than boys.ConclusionsPopulation-based studies of headache disorders are important, as they inform needs assessment and underpin service policy for a disease that is a public-health priority. Headache has a high prevalence among adolescents and carries a significant burden in terms of impact on daily activities and use of medication. Furthermore, underdiagnose is common, while trigger factors are often detectable. Special consideration should be given to female adolescents and self-medication attitudes.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics of headache in Italian adolescents aged 11–16 years: a cross-sectional questionnaire school-based study

Foiadelli¹,

Piccorossi²,

Sacchi³

et al. 2018

Ital J Pediatr

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“…The “childhood periodic syndromes” were renamed by the ICHD-3 as the “episodic syndromes that may be associated with migraine” (44) and include four main conditions: two recurrent gastrointestinal disorders: cyclic vomiting syndrome and abdominal migraine; benign paroxysmal vertigo; benign paroxysmal torticollis. Common features of these disorders are: complete well-being between episodes, stereotypy of episodes, familiarity for migraine or headache (2). Patients with this group of disorders can present with migraine (with or without aura) or are likely to develop them.…”

Section: Primary Headachementioning

confidence: 99%

“…Tension-type headaches (TTH) are common in children with a prevalence of 5–25% in children and adolescents and an average onset age of ~7 years (26). The pain usually arises in the afternoon hours while the child attends school and the child often continues to practice his favorite activities despite severe or constant headaches (2). The average frequency of the attacks is about two per month and the duration about 2 h per single episode.…”

Section: Primary Headachementioning

confidence: 99%

“…Diagnosis and treatment can be challenging due to its varying presentation, etiology, and triggers. Secondary headaches manifest differently in children than in adults and the degree of brain maturation could be the cause of this difference (2, 3). Headache disorders are the main cause of absence from school, affecting negatively school performance (4), as well as other daily activities (5).…”

Section: Introductionmentioning

confidence: 99%

“…Males are more frequently affected at preschool age, while incidence is higher in females in junior-high school age (17, 18). Differential diagnosis of pediatric headache in the ED includes a variety of benign causes and viral infections, sinusitis, migraine, and post-traumatic headaches are the most common diagnoses (2). Burton et al (13) reported viral infections, sinusitis and pharyngitis in over 60% of pediatric patients presenting to the ED for headache.…”

Section: Introductionmentioning

confidence: 99%

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Management of Childhood Headache in the Emergency Department. Review of the Literature

et al. 2019

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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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Can We Really Stop Pediatric Migraine?

Zernikow

2020

JAMA Pediatr

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Pediatric primary headache is one of the leading health care issues in high-income countries that is rising in prevalence. 1 Frequent headaches are strongly associated with a lower quality of life and poorer academic performance and are a leading cause of school absence. 2 The classification system of the International Headache Society provides a navigation system to phenomenologically diagnose migraines, tension-type headaches, and other primary headaches (http://www.ihs-classification.org/_downloads/mixed/ International-Headache-Classification-III-ICHD-III-2013-Beta. pdf); however, pediatric-specific factors have not been considered sufficiently. 3 A migraine is not just a headache-it is a complex neurological condition. More than 60% of children with migraine display a premonitory phase before the migraine attack. It is characterized by various symptoms, such as pallor or shadows under the eyes, fatigue, irritability, anxiety, phonophobia, yawning, photophobia, nausea, and, less commonly, concentration problems, food craving, cacosmia, hyperactivity, stiff neck, neck pain, sadness, and sleep problems. 4 More than 50% of children with migraine show cranial autonomic symptoms, such as a red ear, facial flushing, conjunctival injection, lacrimation, nasal obstruction, facial sweating, ptosis, yawning, rhinorrhea, eyelid edema, or miosis. The cranial symptoms are bilateral in 70% of cases. 5 A migraine attack may also be accompanied by other autonomic symptoms (nausea, vomiting, frequent urination, and diarrhea), affective symptoms (depression and irritability), cognitive symptoms (eg, attention deficit, difficulty finding words, or transient amnesia), and sensory symptoms (photophobia, phonophobia, osmophobia, and cutaneous allodynia). 6 Patients with migraine, especially those with migraine with aura, more often experience various transient sensory and neuropsychological symptoms like visual illusions (eg, autokinesis, corona phenomenon, cinematographic vision, double vision, metamorphopsia, visual splitting, dyschromatopsia, and illusionary visual spread) or complex higher cortical dysfunctions (altered perception of body size, weight, or position in space). 7 Therefore, a useful rule for pediatricians and pediatric neurologists is to believe a child with a migraine who tells you strange stories.Some key differences between children and adults in migraine presentation are evident. For example, during the migraine attack, children often show bifrontal or bitemporal pain instead of the clear pain laterization reported in adults. Additionally, the migraine attack duration in children can be shorter than in adults, for whom it typically lasts many hours. 3 Fur-

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Experts’ opinion about the pediatric secondary headaches diagnostic criteria of the ICHD-3 beta

Cited by 27 publications

References 85 publications

Clinical characteristics of headache in Italian adolescents aged 11–16 years: a cross-sectional questionnaire school-based study

Clinical characteristics of headache in Italian adolescents aged 11–16 years: a cross-sectional questionnaire school-based study

Management of Childhood Headache in the Emergency Department. Review of the Literature

Can We Really Stop Pediatric Migraine?

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