Aromaa M, Sillanpää M, Rautava P, Helenius H
Department of Child Neurology, University of Turku, Finland.
Pediatrics. 2000 Aug;106(2 Pt 1):270-5. doi: 10.1542/peds.106.2.270.
This study reports the pain sensitivity of children with headache and their family members, as well as the prevalence of recurring aches, psychosocial life, and family environment of children with headache at preschool age.
A representative population-based sample of 1443 families expecting their first child were followed over 7 years. A screening questionnaire relating to the child's headache was sent to parents of a representative sample of 1132 6-year-old children. Of 144 children suffering from headache, 106 (76%) were examined and interviewed clinically. Ninety-six children with primary headache (58 migraine and 38 tension-type headache children) and matched controls (n = 96) were included in further examinations.
Children with headache were more often extremely sensitive to pain according to their parents, were more excited about physical examinations, cried more often during blood sampling or vaccination, avoided play or games more often because they were afraid of hurting themselves, and had recurring abdominal and growing pains more often than did control children. The fathers of children with headache were more often extremely sensitive to pain. Children with headache reacted with somatic symptoms, usually with pain and functional intestinal disorders in stress situations, felt more tired, and had more ideations of death during the previous month. They had also had more problems in day care and fewer hobbies such as scout or club meetings than did control children. More mothers of tension-type headache children than those of migraine children reported that they were considerably sensitive to pain. Tension-type headache children also had a poorer family environment; the family atmosphere was more often unhappy and the relationship between the parents was more often distant than in the families of children with migraines.
In addition to somatic factors, it is important to consider the child's pain sensitivity, reaction to various stress situations, and family functioning when studying childhood headache. The child's coping mechanisms can be supported by information given by the parents. School entry can be considered a suitable period for careful investigation into possible occurrence of headache and also for giving information about headache and its management.
本研究报告了头痛儿童及其家庭成员的疼痛敏感性，以及学龄前头痛儿童反复疼痛的患病率、心理社会生活和家庭环境。
对1443个生育头胎的家庭进行了为期7年的基于人群的代表性抽样跟踪研究。向1132名6岁儿童的代表性样本的家长发送了一份与儿童头痛相关的筛查问卷。在144名患有头痛的儿童中，106名（76%）接受了临床检查和访谈。96名原发性头痛儿童（58名偏头痛儿童和38名紧张型头痛儿童）及匹配的对照组（n = 96）纳入进一步检查。
据家长反映，头痛儿童对疼痛往往极为敏感，对体格检查更为兴奋，在采血或接种疫苗时哭得更频繁，因害怕受伤而更频繁地避免玩耍或游戏，且反复出现腹痛和生长痛的情况比对照组儿童更常见。头痛儿童的父亲对疼痛往往极为敏感。头痛儿童在压力情境下会出现躯体症状，通常表现为疼痛和功能性肠道疾病，感觉更疲惫，且在前一个月有更多死亡念头。与对照组儿童相比，他们在日托方面问题更多，参加童子军或俱乐部会议等爱好更少。与偏头痛儿童的母亲相比，紧张型头痛儿童的母亲报告自己对疼痛相当敏感的更多。紧张型头痛儿童的家庭环境也更差；与偏头痛儿童家庭相比，家庭氛围往往更不融洽，父母关系往往更疏远。
在研究儿童头痛时，除了躯体因素外，考虑儿童的疼痛敏感性、对各种压力情境的反应以及家庭功能也很重要。家长提供的信息可以支持儿童的应对机制。可以将入学视为仔细调查头痛可能发生情况以及提供头痛及其管理信息的合适时期。
