Pavone Piero, Conti Irene, Le Pira Alice, Pavone Lorenzo, Verrotti Alberto, Ruggieri Martino
Unit of Pediatrics and Pediatric Emergency, University Hospital Policlinico-Vittorio Emanuele, Department of Pediatrics, University of Catania, Catania, Italy.
Pediatr Int. 2011 Dec;53(6):964-7. doi: 10.1111/j.1442-200X.2011.03493.x.
We report a study conducted in children and adolescents who are affected by primary headaches. The aim was to establish the most useful investigations for diagnosing headaches.
The current study involved 300 consecutively hospitalized children and adolescents selected according to the criteria of the second edition of the International Classification of Headache Disorders. The following examinations were performed in all patients: full ophthalmologic; brain magnetic resonance imaging (MRI); electroencephalography; echocardiogram; and electrocardiogram. Dental, otorhinolaryngology, echocardiography of the supra-aortic trunks, abdominal ultrasound, and visual- and auditory-evoked potentials were carried out in patients according to the clinical signs associated with headache.
In a large number of cases routine laboratory analysis and neurophysiologic investigations were within the normal value when neurologic examination was normal. Electroencephalography, ophthalmologic studies and cerebral MRI are advisable as they can reveal precocious pathologic events, even in the absence of evident or alarming clinical signs.
As widely reported in the literature, most of these investigations may be of little clinical value, but the authors reasoned that electroencephalography, ophthalmologic investigations and a cerebral MRI may be noteworthy because such studies may reveal a precocious pathologic event which can change the prognostic value of the headache. In addition, negative results on cerebral MRI may relieve the anxiety of parents and in turn may positively influence the clinical course of headache in children and adolescents.
我们报告了一项针对受原发性头痛影响的儿童和青少年进行的研究。目的是确定诊断头痛最有用的检查方法。
本研究纳入了300例根据《国际头痛疾病分类》第二版标准连续住院的儿童和青少年。所有患者均进行了以下检查：全面眼科检查；脑磁共振成像（MRI）；脑电图；超声心动图；以及心电图。根据与头痛相关的临床体征，对患者进行牙科、耳鼻喉科、主动脉弓上干超声心动图、腹部超声以及视觉和听觉诱发电位检查。
在大量病例中，当神经系统检查正常时，常规实验室分析和神经生理学检查结果在正常范围内。脑电图、眼科检查和脑部MRI是可取的，因为即使在没有明显或警示性临床体征的情况下，它们也能揭示早期病理事件。
正如文献中广泛报道的那样，这些检查大多可能临床价值不大，但作者认为脑电图、眼科检查和脑部MRI可能值得关注，因为这些研究可能揭示一个能改变头痛预后价值的早期病理事件。此外，脑部MRI的阴性结果可能减轻家长的焦虑，进而可能对儿童和青少年头痛的临床病程产生积极影响。
