Çocukluk Çağı Migren ve Gerilim Tipi Baş Ağrılarının Klinik Özellikleri ve Eeg Bulguları

Year 2017, Volume: 11 Issue: 3, 165 - 170, 01.08.2017

Esra Gürkaş Zeynep Selen Karalök Birce Dilge Taşkın Ümmü Aydoğmuş Cahide Yılmaz

Abstract

Amaç: Baş ağrısı çocuklar ve ergenlerde en sık görülen somatik yakınmadır ve polikliniklere başvuruların büyük bir kısmını oluşturmaktadır. Çalışmada, migren ve gerilim tipi baş ağrısı (GTBA) tanısı konulan çocukların klinik özelliklerinin ve EEG bulgularının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Ocak 2013 ile Aralık 2014 tarihleri arasında baş ağrısı yakınması ile ayaktan çocuk nöroloji polikliniklerine başvuran ve “Baş Ağrısı Bozukluğunun Uluslararası Sınıflaması (3. Baskı-beta versiyonu)” kriterleri temel alınarak migren ve GTBA tanısı konulan hastalar çalışmaya alındı ve hastaların verileri retrospektif olarak değerlendirildi.Bulgular: Toplam 377 hasta çalışmaya alındı. Hastaların yaşları 5 ile 19 yaş arasında değişmekteydi ve yaş ortalaması 12.6±3.1 yaştı. Hastaların % 57.3’ü kızdı. Hastalar migren (218 hasta) ve GTBA (159 hasta) olarak iki gruba ayrıldı. Migren ve GTBA grubunda 12 yaşından sonra belirgin olarak kız oranının arttığı gözlendi. Aylık baş ağrı atak sayısı, baş ağrılarının özellikleri (tek taraflı olması, zonklayıcı vasıfta olması, bulantı, kusma, fotofobi ve fonofobi varlığı, ağrının aktiviteyle tetiklenmesi veya artması), ailede migren öyküsünün varlığı açısından 2 grup arasında anlamlı farklılıklar mevcuttu. EEG çekimi yapılan hastaların %5.3’ünde anormal EEG bulguları saptandı ve iki grup arasında anormal EEG bulguları açısından fark saptanmadı. Migren koyucu tedavisinde hastalarımızda sıklıkla flunarazin, amitriptilin, siproheptadin tedavileri kullanıldı ve sıra ile %81, %67, ve % 71 etkili olduğu görüldü.Sonuç: Çocuklarda görülen tekrarlayan baş ağrıları çocuk ve çocuk nöroloji poliklinikleri için önemli bir hasta yükü oluşturmaktadır. Ayrıntılı bir öykü, dikkatli genel ve nörolojik muayene ile hastaların büyük bir kısmında tanıya yönlenilebilir. Birincil baş ağrısı düşünülen hastalarda ailenin ve hastanın kaygısı da bir ölçüde rahatlatılabilir.

Keywords

Birincil baş ağrısı, Çocuk, Gerilim tipi baş ağrısı, Migren

Clinical Features and EEg Findings in Childhood Migraine and Tension Type Headache

Abstract

Objective: Headache is the most common somatic symptom in children and adolescents and constitutes a large part of the patients who refer to our clinics. This study aimed to evaluate the clinical features and EEG findings of the children who had been diagnosed with migraine and tension type headache (TTH). Material and Methods: Children who were admitted to our outpatient pediatric neurology clinics with the complaint of headache between January 2013 and December 2014 and who were diagnosed with migraine and tension type headache according to the “International Classification of Headache Disorders (3rd Edition beta version)” criteria were included in the study. The records of the patients were evaluated retrospectively. results: A total of 377 patients were enrolled in the study. The patients’ ages ranged from 5 to 19 years and the mean age was 12.6 ± 3.1 years. Females made up 57.3% of the sample. Patients were divided into two groups as migraine (218 patients) and tension type headache (159 patients). In both of the groups, the ratio of the girls increased significantly after 12 years of age. The number of headache attacks per month, the characteristics of the headache (being onesided, a throbbing nature, the presence of nausea, vomiting, photophobia and phonophobia, pain aggravation or triggering with physical activity) and the presence of a family migraine history were significantly different between the two groups. EEG findings were abnormal in 5.3% of the patients who underwent EEG. There was no significant difference in terms of abnormal EEG findings between the migraine and tension type headache groups. Flunarazine, amitriptyline, cyproheptadine were the usually prescribed treatments for migraine prophylaxis in our series and their effectiveness were 81%, 67% and 71% respectively.conclusion: Recurrent headaches in children constitute a huge burden for the child and the child neurology clinics. In the majority of the patients, the diagnosis can be made with a detailed history and a careful general and neurological examination. In patients with primary headache, the anxiety of the family and patient can be relieved to some extent

Keywords

Primary headaches, Children, Tension type headache, Migraine

References

• Ozge A, Termine C, Antonaci F, Natriashvili S, Guidetti V, Wöber- Bingöl C. Overview of diagnosis and management of paediatric headache. Part I: diagnosis. J Headache Pain 2011;12:13-23.
• Dooley JM, Gordon KE, Wood EP. Self-reported headache frequency in Canadian adolescents: Validation and follow-up. Headache 2005;45:127-31.
• Rhee H. Prevalence and predictors of headaches in US adolescents. Headache 2000;40:528-38.
• Karli N, Akiş N, Zarifoğlu M, Akgöz S, Irgil E, Ayvacioğlu U, et al. Headache prevalence in adolescents aged 12 to 17: A student- based epidemiological study in Bursa. Headache 2006;46:649-55.
• Brna PM, Dooley JM. Headaches in the pediatric population. Semin Pediatr Neurol 2006;13:222-30.
• Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33: 629- 808.
• Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, Prensky A, et al. Quality Standards Subcommittee of the American Academy of Neurology; Practice Committee of the Child Neurology Society. Practice parameter: Evaluation of children and adolescents with recurrent headaches: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2002;59:490-8.
• Nejad Biglari H, Rezayi A, Nejad Biglari H, Alizadeh M, Ahmadabadi F. Relationship between migraine and abnormal EEG findings in children. Iran J Child Neurol 2012;6:21-4.
• Rossi P, Schoenen J, Bolla M, Tassorelli C, Sandrini G, Nappi G. Implementation and evaluation of existing guidelines on the use of neurophysiological tests in non-acute migraine patients: A questionnaire survey of neurologists and primary care physicians. Eur J Neurol 2009;16:937-42.
• Piccinelli P, Borgatti R, Nicoli F, Calcagno P, Bassi MT, Quadrelli M, et al. Relationship between migraine and epilepsy in pediatric age. Headache 2006;46:413-21.
• Kramer U, Nevo Y, Neufeld MY, Harel S. The value of EEG in children with chronic headaches. Brain Dev 1994;16:304-8.
• Ozkan M, Teber ST, Deda G. Electroencephalogram variations in pediatric migraines and tension-type headaches. Pediatr Neurol 2012;46:154-7.
• Martens D, Oster I, Gottschlling S, Papanagiotou P, Ziegler K, Eymann R, et al. Cerebral MRI and EEG studies in the initial management of pediatric headaches. Swiss Med Wkly 2012;142:w13625.
• Lewis DW, Yonker M, Winner P, Sowell M. The treatment of pediatric migraine. Pediatr Ann 2005;34:448-60.
• Termine C, Ozge A, Antonaci F, Natriashvili S, Guidetti V, Wöber- Bingöl C. Overview of diagnosis and management of paediatric headache. Part II: Therapeutic management. J Headache Pain 2011;12:25-34.
• Guidetti V, Moscato D, Ottaviano S, Fiorentino D, Fornara R. Flunarizine and migraine in childhood: An evaluation of endocrine function. Cephalalgia 1987;7:263-6.
• Visudtibhan A, Lusawat A, Chiemchanya S, Visudhiphan P. Flunarizine for prophylactic treatment of childhood migraine. J Med Assoc Thai 2004;87:1466-70.
• Lewis DW, Diamond S, Scott D, Jones V. Prophylactic treatment of pediatric migraine. Headache 2004;44:230-7.
• Ozge A, Bugdayci R, Sasmaz T, Kaleagasi H, Kurt O, Karakelle A, et al. The sensitivity and specificity of the case definition criteria in diagnosis of headache: A school-based epidemiological study of 5562 children in Mersin. Cephalalgia 2002;22:791-8.