Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel.
Pediatric Department, Bnai Zion Medical Center, Haifa, Israel.
J Child Neurol. 2021 Jul;36(8):618-624. doi: 10.1177/0883073820988417. Epub 2021 Jan 28.
The International Headache Society criteria were written in order to help physicians establish a headache diagnosis. However, sometimes children with headache do not seem to fit any diagnosis. The purpose of our study was to assess the application of the criteria in a clinical setting.
Medical records of children referred for primary headache to the pediatric neurology clinic at Bnai Zion Medical Center from 2008 to 2017 were assessed.
A total of 989 patients (range 6-18 years; 53% female) were assessed at our neurology clinic. Twenty-four percent (n = 241) were diagnosed with tension-type headache, 26% (n = 256) with migraine, and 4.5% (45) with mixed headache. In 41.5% (410), we were unable to reach a specific diagnosis. No differences in gender or age were found between the groups. Children in the migraine group used more analgesic treatments to stop the headache attacks compared with the tension-type headache group (50% vs 38%, = .001). Patients diagnosed with tension-type headache reported having more emotional difficulties ( = .001). No significant differences were found in headache characteristics (ie, location, sidedness, character), frequency, or intensity between the younger children (ages 6-11) and the adolescents (ages 12-18) within either the tension-type headache or migraine groups.
Retrospective application of International Headache Society criteria in a large cohort of children with headaches failed to diagnose a specific type of headache in 41.5% of children. Migraine and tension-type headache were equally prevalent, and both constituted a major burden on our patients' everyday lives. We found no major differences in frequency, intensity, and characteristics of pain between younger children and adolescents.
国际头痛协会制定的标准旨在帮助医生确立头痛诊断。然而，有时患有头痛的儿童似乎无法符合任何诊断标准。我们研究的目的是评估这些标准在临床实践中的应用。
评估了 2008 年至 2017 年期间因原发性头痛而转诊至拜奈辛医疗中心儿科神经科诊所的儿童的病历。
在我们的神经科诊所共评估了 989 名患者（年龄 6-18 岁；女性占 53%）。24%（n=241）被诊断为紧张型头痛，26%（n=256）为偏头痛，4.5%（45）为混合型头痛。41.5%（410）的患者无法确定具体诊断。各组之间在性别或年龄上没有差异。与紧张型头痛组相比，偏头痛组使用更多的镇痛治疗来停止头痛发作（50%对 38%， =.001）。诊断为紧张型头痛的患者报告有更多的情绪困难（ =.001）。在紧张型头痛或偏头痛组内，无论是年龄较小的儿童（6-11 岁）还是青少年（12-18 岁），头痛的特征（即位置、偏侧性、性质）、频率或强度均无显著差异。
在一个患有头痛的大儿童队列中回顾性应用国际头痛协会标准，41.5%的儿童无法确定特定类型的头痛。偏头痛和紧张型头痛同样普遍，都给患者的日常生活带来了很大的负担。我们没有发现年龄较小的儿童和青少年之间在疼痛频率、强度和特征方面有重大差异。
