Uluduz Derya, Tavsanli Mustafa Emir, Uygunoğlu Uğur, Saip Sabahattin, Kasapcopur Ozgur, Ozge Aynur, Temel Gulhan Orekici
Istanbul University, Cerrahpasa Medical Faculty, Neurology Department, Istanbul, Turkey.
Istanbul University, Cerrahpasa Medical Faculty, Neurology Department, Istanbul, Turkey.
Brain Dev. 2014 Nov;36(10):884-91. doi: 10.1016/j.braindev.2014.01.009. Epub 2014 Feb 15.
To assess the presence, prevalence and clinical characteristics of primary headaches in pediatric patients with chronic rheumatic diseases such as juvenile idiopathic arthritis (JIA) and familial Mediterranean fever (FMF), and to analyze the common pathophysiological mechanisms.
In this noncontrolled, cross-sectional study, a semi-structured 53 item headache questionnaire was administered to subjects with FMF and JIA, and interviewed a total sample size of 601 patients younger than16years of age. The questionnaires were then analyzed according to the International Headache Society's diagnostic criteria.
Children with FMF (n=378) and JIA (n=223) were studied. Each group was then divided into two subgroups according to whether the subjects reported headache or not. 29.5% of subjects with FMF reported having migraine, 37.6% probable migraine and 32.9% tension type headache (TTH). In JIA group 28.2% were diagnosed with migraine; 41.2% with probable migraine and 30.6% with TTH. No significant difference was found between all subjects with (n=258) and without (n=343) headache for variables such as living in a crowded family (p=0.95), being the first child in the family (p=0.63), academic achievement of the child (p=0.63), high education level (higher than high school) of the mother (p=0.52) and father (p=0.46). The presence of systemic disease was reported not to be effecting the daily life at the time of evaluation by 90.2% of the children with headache and 91.0% of the children without headache (p=0.94). 81.4% of the children reported their headaches were not aggravating with the exacerbation periods of their systemic disease. Family history of hypertension was reported higher by the subjects with headache (13.5% with headache and 4.0% without headache p=0.001). Diabetes mellitus was also reported higher (5.8% with headache; 0.5% without headache; p=0.006). Family history of headache was reported in 28.2% of the patients with headache whereas it was 17.4% of the patients without headache (p<0.001). Family history of headache was reported in 28.2% of the FMF subjects with headache whereas it was 17.4% of the patients without headache (p<0.001). For JIA patients a positive family history for headache was obtained in 25.9% of children with headache notably in migraineurs (81.8%).
Patients with JIA and FMF should be asked specifically about accompanying primary headaches particularly migraine headaches as they may be additional disabilities for these patients.
评估患有慢性风湿性疾病（如幼年特发性关节炎（JIA）和家族性地中海热（FMF））的儿科患者原发性头痛的存在情况、患病率及临床特征，并分析常见的病理生理机制。
在这项非对照横断面研究中，对患有FMF和JIA的受试者发放了一份包含53个条目的半结构化头痛问卷，并对601名16岁以下患者进行了访谈。然后根据国际头痛协会的诊断标准对问卷进行分析。
对378例FMF患儿和223例JIA患儿进行了研究。然后根据受试者是否报告有头痛，将每组再分为两个亚组。29.5%的FMF受试者报告有偏头痛，37.6%可能患有偏头痛，32.9%患有紧张型头痛（TTH）。在JIA组中，28.2%被诊断为偏头痛；41.2%可能患有偏头痛，30.6%患有TTH。在所有有（n = 258）和无（n = 343）头痛的受试者中，在诸如生活在拥挤家庭（p = 0.95）、是家庭中的第一个孩子（p = 0.63）、孩子的学业成绩（p = 0.63）、母亲（p = 0.52）和父亲（p = 0.46）的高教育水平（高于高中）等变量方面未发现显著差异。90.2%有头痛的儿童和91.0%无头痛的儿童报告在评估时全身性疾病的存在未影响日常生活（p = 0.94）。81.4%的儿童报告他们的头痛不会随着全身性疾病的加重期而加重。有头痛的受试者报告高血压家族史较高（有头痛者为13.5%，无头痛者为4.0%，p = 0.001）。糖尿病的报告率也较高（有头痛者为5.8%；无头痛者为0.5%；p = 0.006）。28.2%有头痛的患者报告有头痛家族史，而无头痛的患者为17.4%（p<0.001）。28.2%有头痛的FMF受试者报告有头痛家族史，而无头痛的患者为17.4%（p<0.001）。对于JIA患者，25.9%有头痛的儿童有头痛家族史，尤其是偏头痛患者（81.8%）。
应特别询问JIA和FMF患者是否伴有原发性头痛，尤其是偏头痛，因为这可能是这些患者的额外残疾。
