Clinical Characteristics of Patients Presenting to Child Neurology Outpatient Clinic with Headache: A Single Center Experience

Abstract

Aim: This study aimed to investigate the clinical and etiological characteristics of children presenting with headache, considering both acute and chronic cases. By distinguishing between primary and secondary headaches, it was aimed to assess the prevalence of underlying pathologies and determine the necessity of further diagnostic evaluations. Material and Methods: The records of 500 patients aged 3-17 years who visited a tertiary pediatric neurology clinic between January 2023 and January 2024 were retrospectively reviewed. Data included age, gender, pain characteristics, associated symptoms, headache subtypes, neuroimaging findings, and treatments. Headaches were classified according to the International Headache Society criteria. Results: Among the patients, 64.8% (n=324) were female. Acute headaches were present in 137 (27.4%) patients, while 363 (72.6%) patients had chronic headaches. Secondary causes were identified in 56.2% (n=77) of acute headaches, most commonly sinusitis (36.5%, n=50) and hypertension (12.4%, n=17). Among primary acute headaches, migraine (23.4%, n=32) and tension-type headache (20.4%, n=28) were the leading diagnoses. Overall, in all 500 patients, migraine (28.6%, n=143) was the most common diagnosis, followed by tension-type headache (27.8%, n=139). Refractive errors and hypertension were observed in 4.6% (n=23). Idiopathic intracranial hypertension was also diagnosed in 0.8% (n=4). Conclusion: Most childhood headaches are primary and manageable with a detailed history and physical examination. However, secondary causes such as sinusitis, hypertension, and nutritional deficiencies should be considered in the differential diagnosis. Neuroimaging and laboratory evaluations are recommended for patients with abnormal findings. Understanding headache etiology can improve diagnosis, management, and quality of life.

Keywords

• Headache
• migraine
• tension-type headache
• child
• pediatric neurology

Baş Ağrısı ile Çocuk Nöroloji Polikliniğine Başvuran Hastaların Klinik Özellikleri: Tek Merkez Deneyimi

Abstract

Amaç: Bu çalışmanın amacı, hem akut hem de kronik olguları göz önünde bulundurarak baş ağrısı ile başvuran çocukların klinik ve etiyolojik özelliklerini araştırmaktır. Primer ve sekonder baş ağrıları arasındaki ayrımı yaparak, altta yatan patolojilerin prevalansını değerlendirmek ve ileri tanı yöntemlerinin gerekliliğini belirlemek amaçlanmıştır. Gereç ve Yöntemler: Ocak 2023 ile Ocak 2024 tarihleri arasında üçüncü basamak bir pediatrik nöroloji kliniğine başvuran 3-17 yaş arası 500 hastanın kayıtları geriye dönük olarak incelendi. Veriler, yaş, cinsiyet, ağrı özellikleri, eşlik eden semptomlar, baş ağrısı alt tipleri, nörogörüntüleme bulguları ve tedavi bilgilerini içermekteydi. Baş ağrıları, Uluslararası Baş Ağrısı Derneği kriterlerine göre sınıflandırıldı. Bulgular: Hastaların %64,8'i (n=324) kadındı. Akut baş ağrısı 137 (%27,4) hastada, kronik baş ağrısı 363 (%72,6) hastada mevcuttu. Akut baş ağrılarının %56,2'sinde (n=77) sekonder nedenler, en sık sinüzit (%36,5, n=50) ve hipertansiyon (%12,4, n=17), belirlendi. Primer akut baş ağrıları arasında migren (%23,4, n=32) ve gerilim tipi baş ağrısı (%20,4, n=28) önde gelen tanılardı. Genel olarak, 500 hastada migren (%28,6, n=143) en sık tanı iken, bunu gerilim tipi baş ağrısı (%27,8, n=139) takip etti. Refraksiyon kusurları ve hipertansiyon %4,6 (n=23) oranında gözlendi. Ayrıca %0,8 (n=4) idiyopatik intrakranial hipertansiyon tanısı konuldu. Sonuç: Çocukluk çağı baş ağrılarının çoğu primer nedenlidir ve ayrıntılı öykü ve fizik muayene ile yönetilebilir. Ancak sinüzit, hipertansiyon ve nutrisyonel eksiklikler gibi sekonder nedenler ayırıcı tanıda dikkate alınmalıdır. Anormal bulguların varlığında nörogörüntüleme ve laboratuvar testleri önerilmektedir. Baş ağrısının etiyolojisini anlamak tanı, tedavi ve yaşam kalitesini iyileştirmeye katkı sağlayabilir.

Keywords

• Baş ağrısı
• migren
• gerilim tipi baş ağrısı
• çocuk
• pediatrik nöroloji

References

1. Szperka C. Headache in children and adolescents. Continuum (Minneap Minn). 2021;27(3):703-31.
2. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
3. Abidin I, Ugur C, Yildirim M. Retrospective evaluation of patients admitted to the pediatric neurology outpatient clinic with headache: experience of a tertiary hospital. Sisli Etfal Hastan Tip Bul. 2024;58(1):109-15.
4. Merison K, Victorio MCC. Approach to the diagnosis of pediatric headache. Semin Pediatr Neurol. 2021;40:100920.
5. Blume HK. Childhood headache: a brief review. Pediatr Ann. 2017;46(4):e155-65.
6. Lakshmikantha KM, Nallasamy K. Child with headache. Indian J Pediatr. 2018;85(1):66-70.
7. Albers L, von Kries R, Heinen F, Straube A. Headache in school children: is the prevalence increasing? Curr Pain Headache Rep. 2015;19(3):4.
8. Straube A, Heinen F, Ebinger F, von Kries R. Headache in school children: prevalence and risk factors. Dtsch Arztebl Int. 2013;110(48):811-8.

9. Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol. 2010;52(12):1088-97.
10. Karli N, Akgoz S, Zarifoglu M, Akis N, Erer S. Clinical characteristics of tension-type headache and migraine in adolescents: a student-based study. Headache. 2006;46(3):399-412.
11. Gupta S, Mehrotra S, Villalon CM, Perusquia M, Saxena PR, MaassenVanDenBrink A. Potential role of female sex hormones in the pathophysiology of migraine. Pharmacol Ther. 2007;113(2):321-40.
12. Deda G, Caksen H, Ocal A. Headache etiology in children: a retrospective study of 125 cases. Pediatr Int. 2000;42(6):668-73.
13. Onofri A, Pensato U, Rosignoli C, Wells-Gatnik W, Stanyer E, Ornello R, et al. Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis. J Headache Pain. 2023;24(1):8.
14. Aydin M, Bozdag S, Kabakus N. Headaches in childhood. Turkiye Klinikleri J Med Sci. 2010;30(6):1928-36. Turkish.
15. Demirel H, Emre U, Atasoy T, Unal A, Ankarali H. The association between hematological parameters, migraine and tension-type headache. Turk J Neurol. 2008;14(6):394-8. Turkish.
16. Sari US, Kama Basci O. Association between anemia severity and migraine in iron deficiency anemia. Eur Rev Med Pharmacol Sci. 2024;28(3):995-1001.
17. Singh RK, Kaushik RM, Goel D, Kaushik R. Association between iron deficiency anemia and chronic daily headache: a case-control study. Cephalalgia. 2023;43(2):3331024221143540.
18. Deschenes ER, Do J, Tsampalieros A, Webster RJ, Whitley N, Ward LM, et al. Pediatric headache patients are at high risk of vitamin D insufficiency. J Child Neurol. 2025;40(2):91-8.
19. Ioannidou E, Tsakiris C, Goulis DG, Christoforidis A, Zafeiriou D. The association of serum vitamin D concentrations in paediatric migraine. Eur J Paediatr Neurol. 2023;47:60-6.
20. Roth Z, Pandolfo KR, Simon J, Zobal-Ratner J. Headache and refractive errors in children. J Pediatr Ophthalmol Strabismus. 2014;51(3):177-9.
21. Dotan G, Stolovitch C, Moisseiev E, Cohen S, Kesler A. Uncorrected amteropia among children hospitalized for headache evaluation: a clinical descriptive study. BMC Pediatr. 2014;14:241.
22. Lajmi H, Choura R, Ben Achour B, Doukh M, Amin Z, Hmaied W. Headache associated with refractive errors: characteristics and risk factors. Rev Neurol (Paris). 2021;177(8):947-54.
23. Kharbanda EO. Epidemiology of hypertension and cardiovascular disease in children and adolescents. In: Flynn JT, Ingelfinger JR, Brady TM, editors. Pediatric hypertension. Cham: Springer; 2023. p.367-86.
24. Arca KN, Halker Singh RB. The hypertensive headache: a review. Curr Pain Headache Rep. 2019;23(5):30.
25. Barmherzig R, Szperka CL. Pseudotumor cerebri syndrome in children. Curr Pain Headache Rep. 2019;23(8):58.
26. Phillips PH, Sheldon CA. Pediatric pseudotumor cerebri syndrome. J Neuroophthalmol. 2017;37(Suppl 1):S33-40.
27. Gladstein J. Headache. In: McInerny TK, Adam HM, Campbell DE, DeWitt TG, Foy JM, Kamat DM, editors. American Academy of Pediatrics textbook of pediatric care, 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017. p.1404-7.
28. Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, Prensky A, et al. 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(4):490-8.