Ferrari Anna, Pileri Francesca, Spaccapelo Luca, Zappaterra Maurizio, Ruggerini Ciro, Tacchi Raffaella, Bertolini Alfio
Headache Centre, Division of Toxicology and Clinical Pharmacology, University of Modena and Reggio Emilia, Modena, Italy.
Headache. 2009 Feb;49(2):194-201. doi: 10.1111/j.1526-4610.2008.01325.x.
While adult headache patients' satisfaction with treatments has been widely investigated, less attention has been paid to children and adolescent headache patients' opinions and their parents' views.
The aim of our follow-up survey was to analyze the outcomes of the Headache Centre's intervention and the evolution of headache according to patients until the age of 16 and their parents.
We studied all outpatients suffering from episodic primary headache according to International Classification of Headache Disorders 2nd edition criteria, seen for the first time in 2005-2006 at the Headache Centre of the University Hospital of Modena (Italy), and at least one of their parents. The duration of the follow-up ranged from 1 to 3 years. For the purpose of the study, a specific questionnaire was created and administered by a telephone interview.
We enrolled 84 patients (38 females, 45%; 46 males, 55%; mean age +/- SD: 12.9 +/- 2.9 years) with primary headache: migraine without aura 66%, episodic tension-type headache 23%, migraine with aura 11%. At the follow-up, 70% of the patients reported that headache had improved; frequency had decreased significantly more than severity (P = .000, Fisher's exact test), both in those who had followed a prophylactic treatment and in those who had not. A high percentage of the children and parents could precisely indicate trigger factors for headache: especially excessive worrying and studying. The patients reporting an improvement attributed it to pharmacological prophylactic treatment, but also to other factors: first of all, better school results and more happiness than before. Seventy-seven percent of the parents thought that the Headache Centre's intervention had helped them to better understand and manage their children's headache.
Children's and adolescents' headache has in most cases a favorable prognosis; the Headache Centre's intervention is considered effective by most parents. We must increase and focus therapeutic efforts addressed to the few patients with worsening headaches in spite of treatment, since these children's/adolescents' headache also is at risk to progress in the adult age.
虽然成人头痛患者对治疗的满意度已得到广泛研究,但儿童和青少年头痛患者的意见及其父母的看法却较少受到关注。
我们的随访调查旨在根据16岁及以下患者及其父母的情况,分析头痛中心干预的结果以及头痛的演变情况。
我们研究了所有符合《国际头痛疾病分类》第2版标准的发作性原发性头痛门诊患者,这些患者于2005 - 2006年首次在意大利摩德纳大学医院头痛中心就诊,以及他们的至少一位父母。随访时间为1至3年。为了这项研究,我们创建了一份特定的问卷,并通过电话访谈进行发放。
我们纳入了84例原发性头痛患者(38例女性,占45%;46例男性,占55%;平均年龄±标准差:12.9±2.9岁):无先兆偏头痛占66%,发作性紧张型头痛占23%,有先兆偏头痛占11%。在随访中,70%的患者报告头痛有所改善;无论是接受预防性治疗的患者还是未接受预防性治疗的患者,头痛发作频率的下降都明显大于严重程度(P = 0.000,Fisher精确检验)。很大比例的儿童和父母能够准确指出头痛的触发因素:尤其是过度担忧和学习。报告病情改善的患者将其归因于药物预防性治疗,但也归因于其他因素:首先是学习成绩提高和比以前更快乐。77%的父母认为头痛中心的干预帮助他们更好地理解和管理孩子的头痛。
儿童和青少年头痛在大多数情况下预后良好;大多数父母认为头痛中心的干预是有效的。我们必须加大并集中针对少数尽管接受了治疗但头痛仍恶化的患者的治疗力度,因为这些儿童/青少年的头痛在成年后也有进展的风险。