Çocukluk Çağı Migren ve Gerilim Tipi Baş Ağrılarında Klinik Özellikler, Risk Faktörleri ve İzlem

Abstract

Giriş ve Amaç: Baş ağrısı, hastaların yaşam kalitesini etkileyen ve pediyatri pratiğinde sık karşılaşılan hastalıklardan biridir. Bu çalışmada çocukluk ve ergenlikte migren ve gerilim tipi baş ağrısında ayırıcı tanı, predispozan faktörler, klinik izlem ve tedavinin önemini vurgulamak istedik.Materyal ve Metod: Ankara Üniversitesi Tıp Fakültesi Çocuk Nörolojisi Bilim Dalına Haziran 2007-Temmuz 2008 tarihleri arasında baş ağrısı nedeniyle başvuran hastalar içinde migren tanısı konulan 50 hasta, gerilim tipi baş ağrısı tanısı konulan 50 hasta çalışmaya alınmıştır. Migren ve gerilim tipi baş ağrısı tanısı Uluslararası Baş Ağrısı Derneği’nin “Baş Ağrısı Bozukluklarının Uluslararası Sınıflandırması” temel alınarak konulmuştur. Çalışmaya katılan tüm çocukların demografik ve klinik verileri prospektif olarak toplanmıştır.Bulgular: Tüm hastaların 60’ı kız olup cinsiyet açısından karşılaştırıldığında migren ve gerilim tipi baş ağrısı hastaları arasında anlamlı fark bulunmadı. Hastaların yaş ortalaması 11.81±3.05 (5-16) yıl olup, gerilim tipi baş ağrısı grubunda migren grubuna göre yaş ortalaması istatistiksel olarak anlamlı derecede daha yüksekti (13.00±2.37 yıl ve 10.62±3.21 yıl). Ailede baş ağrısı öyküsü migren grubunda %52, gerilim tipi baş ağrısı grubunda %18 olarak bulundu. Otuz altı hasta (17 migren, 19 gerilim tipi baş ağrısı hastası) ağrıyı tetikleyici faktör bildirdi. Otuz dört migren hastasına ve 13 gerilim tipi baş ağrısı hastasına günlük koruyucu tedavi başlandı.Sonuç: Aile öyküsü migren grubunda yüksek risk faktörü olarak bulunurken her iki grupta da tetikleyici faktör oranları benzer bulunmuştu ve stres en sık bildirilen faktördü. Koruyucu tedavi başlanan 47 hastanın ağrı sıklığı ve şiddeti azaldı. Baş ağrısı; yaşam kalitesini etkileyen kronik bir hastalıktır ve ayırıcı tanısı, klinik izlem ve tedavisi önemlidir.

Keywords

• Çocuk, birincil baş ağrısı, migren, gerilim tipi baş ağrısı

CLINICAL FEATURES, PREDISPOSING FACTORS AND MONITORING IN PEDIATRIC MIGRAINES AND TENSION TYPES HEADACHES

Abstract

Introduction: Headache is an ailment which has a major impact on the patients’ quality of life and is frequently encountered in the practice of pediatrics. We wanted to emphasize the importance of differential diagnosis, predisposing factors, clinical features and treatment of migraines and tension type headache in children and adolescents in this study. Material and Method: The study involved 50 patients having migraine and 50 tension type headache patients consecutively diagnosed in our pediatric neurology clinic between June 2007 and June 2008. The diagnosis was formulated in a manner based on ‘’International Classification of Headache Disorders’’ criteria published by International Headache Society. Demographic and clinical data were collected prospectively on all children. Results: There were 60 girls of all patients and no significant difference between migraine and tension type headache patients in terms of gender. Mean age was 11.81±3.05 years in all over; while mean age was significantly higher in tension type headache group than migraine group, those given in respectively (13.00±2.37 years v.s. 10.62±3.21 years). A positive family history has 52% migraine group and 18% tension type headache group. Thirty-six patients (17 migraine, 19 tension type headache patiens) reported precipitating factors. Thirty-four migraine patients and 13 tension type headache patients treated with daily prophylaxis agents.Conclusion: While family history is found to be a high risk factor for migraine group, the triggering factor rates have been found to be similar in both groups and stress is the most frequently indicated factor. The frequency and intensity of headaches in 47 patients, in the early stages of protective treatment, were lessened. Headache is a chronic illness that has an impact on patients’ quality of life and its differential diagnosis, clinical features, and treatment are crucial

Keywords

• Children, primer headache, migrain, tension type headache

References

1. Sillanpaa M, Anttila P. Increasing prevalence of headache in 7-year-old school children. Headache 1996;36(8):466-70.
2. Balottin U, Termine C, Nicoli F, Quadrelli M, Ferrari-Ginevra O, Lanzi G. Idiopathic headache in children under six years of age: a follow-up study. Headache 2005;45(6):705-15.
3. Battistella PA, Fiumana E, Binelli M, Bertossi E, Battista P, Perakis E, et al. Primary headaches in preschool age child- ren: clinical study and follow-up in 163 patients. Cephalalgia 2006;26(2):162-71.
4. Stovner L, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007;27(3):193-210.
5. Roth-Isigkeit A, Thyen U, Stoven H, Schwarzenberger J, Schmucker P. Pain among children and adolescents: rest- rictions in daily living and triggering factors. Pediatrics 2005;115(2):e152-62.
6. Bille BS. Migraine in school children. A study of the inci- dence and short-term prognosis, and a clinical, psychologi- cal and electroencephalographic comparison between child- ren with migraine and matched controls. Acta Paediatr Suppl 1962;136:1-151.
7. Laurell K, Larsson B, Eeg-Olofsson O. Prevalence of headac- he in Swedish schoolchildren, with a focus on tension-type he- adache. Cephalalgia 2004;24(5):380-8.
8. Kienbacher C, Wober C, Zesch HE, Hafferl-Gattermayer A, Posch M, Karwautz A, et al. Clinical features, classification and prognosis of migraine and tension-type headache in child- ren and adolescents: a long-term follow-up study. Cephalalgia 2006;26(7):820-30.

9. Bille B. A 40-year follow-up of school children with migraine. Cephalalgia 1997;17(4):488-91.
10. Akyol A, Kiylioglu N, Aydin I, Erturk A, Kaya E, Telli E, et al. Epidemiology and clinical characteristics of migraine among school children in the Menderes region. Cephalalgia 2007;27(7):781-7.
11. Ozge A, Bugdayci R, Sasmaz T, Kaleagasi H, Kurt O, Kara- kelle A, et al. The sensitivity and specificity of the case defi- nition criteria in diagnosis of headache: a school-based epi- demiological study of 5562 children in Mersin. Cephalalgia 2002;22(10):791-8.
12. Silberstein SD, Olesen J, Bousser MG, Diener HC, Dodick D, First M, et al. The International Classification of Headac- he Disorders, 2nd Edition (ICHD-II)--revision of criteria for 8.2 Medication-overuse headache. Cephalalgia 2005;25(6):460-5.
13. Zwart JA, Dyb G, Holmen TL, Stovner LJ, Sand T. The pre- valence of migraine and tension-type headaches among ado- lescents in Norway. The Nord-Trondelag Health Study (Head- HUNT-Youth), a large population-based epidemiological study. Cephalalgia 2004;24(5):373-9.
14. Mortimer MJ, Kay J, Jaron A. Epidemiology of headac- he and childhood migraine in an urban general practice using Ad Hoc, Vahlquist and IHS criteria. Dev Med Child Neurol 1992;34(12):1095-101.
15. Gallai V, Sarchielli P, Carboni F, Benedetti P, Mastropaolo C, Puca F. Applicability of the 1988 IHS criteria to headache pati- ents under the age of 18 years attending 21 Italian headache cli- nics. Juvenile Headache Collaborative Study Group. Headache 1995;35(3):146-53.
16. Lewis DW. Toward the definition of childhood migraine. Curr Opin Pediatr 2004;16(6):628-36.
17. Gudmundsson LS, Scher AI, Aspelund T, Eliasson JH, Johann- sson M, Thorgeirsson G, et al. Migraine with aura and risk of cardiovascular and all cause mortality in men and women: pros- pective cohort study. BMJ 2010;341:3966.
18. Winner P, Rothner AD. Headache in children and adolescents. Hamilton, Ont. ; London: B C Decker; 2001.
19. Millichap JG, Yee MM. The diet factor in pediatric and adoles- cent migraine. Pediatr Neurol 2003;28(1):9-15.
20. Russell MB, Iselius L, Olesen J. Migraine without aura and migraine with aura are inherited disorders. Cephalalgia 1996;16(5):305-9.
21. Stewart WF, Bigal ME, Kolodner K, Dowson A, Liberman JN, Lipton RB. Familial risk of migraine: variation by proband age at onset and headache severity. Neurology 2006;66(3):344-8.
22. Esposito SB, Gherpelli JL. Chronic daily headaches in children and adolescents: a study of clinical characteristics. Cephalalgia 2004;24(6):476-82.
23. Bugdayci R, Ozge A, Sasmaz T, Kurt AO, Kaleagasi H, Kara- kelle A, et al. Prevalence and factors affecting headache in Tur- kish schoolchildren. Pediatr Int 2005;47(3):316-22.
24. Lewis DW, Yonker M, Winner P, Sowell M. The treatment of pediatric migraine. Pediatr Ann 2005;34(6):448-60.
25. Lewis DW, Diamond S, Scott D, Jones V. Prophylactic treat- ment of pediatric migraine. Headache 2004;44(3):230-7.
26. Schoenen J. Beta blockers and the central nervous system. Cep- halalgia 1986;6:47-54.
27. Brandes JL, Saper JR, Diamond M, Couch JR, Lewis DW, Schmitt J, et al. Topiramate for migraine prevention: a randomi- zed controlled trial. JAMA 2004;291(8):965-73.
28. de Tommaso M, Marinazzo D, Nitti L, Pellicoro M, Guido M, Serpino C, et al. Effects of levetiracetam vs topiramate and pla- cebo on visually evoked phase synchronization changes of alp- ha rhythm in migraine. Clin Neurophysiol 2007;118(10):2297- 304.
29. Thomaides T, Karapanayiotides T, Kerezoudi E, Avramidis T, Haeropoulos C, Zoukos Y, et al. Intravenous valproate aborts glyceryl trinitrate-induced migraine attacks: a clinical and qu- antitative EEG study. Cephalalgia 2008;28(3):250-6.
30. Jay GW, Renelli D, Mead T. The effects of propranolol and amitriptyline on vascular and EMG biofeedback training. He- adache 1984;24(2):59-69.
31. Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, et al. EFNS guideline on the drug treatment of migraine--revised re- port of an EFNS task force. Eur J Neurol 2009;16(9):968-81.
32. Abbass A, Lovas D, Purdy A. Direct diagnosis and management of emotional factors in chronic headache patients. Cephalalgia 2008;28(12):1305-14.
33. Abu-Arafeh I. Chronic tension-type headache in children and adolescents. Cephalalgia 2001;21(8):830-6.
34. Anttila P, Sourander A, Metsahonkala L, Aromaa M, Hele- nius H, Sillanpaa M. Psychiatric symptoms in children with primary headache. J Am Acad Child Adolesc Psychiatry 2004;43(4):412-9.