RESUMO
Headache is one of the most common symptoms in children and adolescents, and headache syndromes are an important reason for medical consulting. According to the second edition of the International Classification of Headache Disorders, there are 196 possible headache diagnoses, of which 113 have been described in pediatric population. Herein, we focus on unusual pediatric headache syndromes. We group them as headaches with migraine features, short-duration headaches with autonomic features, short-duration headaches without autonomic features, and potentially ominous forms of headaches. Although rare as single entities, providers focusing on pediatric headaches certainly will face some of these headaches and need to be comfortable on the diagnostic approach.
Assuntos
Transtornos da Cefaleia/epidemiologia , Adolescente , Neoplasias Encefálicas/complicações , Criança , Doença Crônica , Cefaleia Histamínica/epidemiologia , Cefaleia Histamínica/terapia , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/etiologia , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Oftalmoplegia/complicações , Neuralgia do Trigêmeo/complicaçõesRESUMO
The objective of the present study was to estimate the prevalence and relative risk of symptoms suggestive of childhood periodic syndrome in migraine, migraine subtypes, and tension-type headache, relative to control subjects. The target population was all children (age 5-12 years) enrolled in public elementary schools in one Brazilian city (n = 2173). Consent was obtained for 1994 children; analyzable data were available for 1906 children, for a final sample of 1113 children with migraine, tension-type headache, or no headache. Parents were interviewed using validated questionnaires. Headache diagnosis was assigned according to the International Classification of Headache Disorders, 2nd edition. Relative risk of symptoms was drawn by headache categories relative to controls. For episodic migraine, the relative risk of all symptoms except nocturnal enuresis was significantly increased: motion sickness, recurrent limb pain, recurrent abdominal pain, and parasomnias, such as sleep talking, somnambulism, and bruxism. For tension-type headache, only nocturnal enuresis and motion sickness were not more common than in controls. In multivariate analyses, any interictal symptom was independently associated with any headache (P < 0.001), migraine headaches (P < 0.001), and tension-type headaches (P < 0.01). These findings indicate that interictal symptoms suggestive of childhood periodic syndromes are common in the population, and are associated with migraine and specific migraine subtypes, but also with tension-type headache.
Assuntos
Transtornos de Enxaqueca/epidemiologia , Periodicidade , Cefaleia do Tipo Tensional/epidemiologia , Brasil/epidemiologia , Criança , Pré-Escolar , Humanos , Entrevistas como Assunto , Transtornos de Enxaqueca/diagnóstico , Análise Multivariada , Prevalência , Risco , Inquéritos e Questionários , Cefaleia do Tipo Tensional/diagnósticoRESUMO
OBJECTIVES: Primary headache syndromes (eg, migraine and tension-type headache [TTH]) and attention-deficit/hyperactivity disorder (ADHD) are prevalent in childhood and may cause impairment in social and academic functioning. We tested if ADHD or its symptoms are associated with specific headache syndromes or with headache frequency. STUDY DESIGN: Cross-sectional epidemiological study with direct interviews to parents and teachers using validated and standardized questionnaires. SETTING: Populational study. PARTICIPANTS: Children aged 5 to 11 years (n = 1856). OUTCOME MEASURES: Prevalence of ADHD as a function of headache status in crude and adjusted analyses. RESULTS: The prevalence of migraine was 3.76%. Infrequent episodic TTH occurred in 2.3% of the sample, and frequent episodic TTH occurred in 1.6%. The prevalence of ADHD was 6.1%. The prevalence of ADHD was not significantly different by headache category. For hyperactivity-impulsivity symptoms, the prevalence was 8.1% in children without headache, 23.7% in children with migraine (relative risk [RR], 2.6; 95% confidence interval [CI], 1.6-4.2), and 18.4% in children with probable migraine (RR, 2.1; 95% CI, 1.4-3.2). For inattention, no significant differences were seen. In multivariate analyses, ADHD or inattention symptoms were not predicted by headache subtypes or headache frequency. Hyperactivity-impulsivity symptoms were significantly associated with any headache (P < 0.01), TTH (P < 0.01), or migraine (P < 0.001). CONCLUSION: Migraine and TTH are not comorbid to ADHD overall, but are comorbid to hyperactive-impulsive behavior. Providers and educators should be aware of the association.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Cefaleia do Tipo Tensional/epidemiologia , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Comportamento Impulsivo/epidemiologia , Renda , Masculino , Análise Multivariada , Prevalência , Fatores SexuaisRESUMO
The aim of this study was to estimate the prevalence of primary headaches in pre-adolescent children, as well as headache frequency and days of treatment in this population. Sample consisted of 1994 children (aged 5-12 years). Parents were interviewed by a paediatric headache specialist using a questionnaire that allowed the classification of headaches using the criteria of the Second Edition of the International Classification of Headache Disorders. The most severe headache type was classified (mutually-exclusive diagnoses). Prevalence and prevalence ratios were calculated overall, as well as by age, gender and race. The overall prevalence of migraine was 3.76%, non-significantly higher in boys (3.9%) than in girls (3.6%). Prevalence of probable migraine was significantly higher than the prevalence of migraine for all ages (overall prevalence of 17.1%). Chronic migraine (CM) happened in 0.8% (girls, 1.15%; boys, 0.5%). Infrequent episodic tension-type headache (ETTH) happened in 2.3% of the sample while prevalence of frequent ETTH was 1.6%. Probable TTH happened in 13.5%. Most children with migraine had consulted a medical doctor because of their headaches, and the proportion was higher among children with CM (93.7%). Prevalence of primary headaches is high in young children. Probable diagnoses are more common than full diagnoses. Consultation rates are elevated.
Assuntos
Transtornos de Enxaqueca/epidemiologia , Cefaleia do Tipo Tensional/epidemiologia , Distribuição por Idade , Brasil/epidemiologia , Criança , Pré-Escolar , Doença Crônica , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/tratamento farmacológico , Prevalência , Encaminhamento e Consulta/estatística & dados numéricos , Distribuição por Sexo , Cefaleia do Tipo Tensional/tratamento farmacológicoRESUMO
A pesquisa das cefaleias na infância vive hoje uma grande evolução de conceitos. O reconhecimento das numerosas peculiaridades observadas na migrânea na infância e adolescência, consequência da interação de processos neuroquímicos e maturacionais subjacentes, pode ajudar-nos a compreender melhor os processos de dor em um sistema nervoso em franco desenvolvimento. Com esse racional, valemo-nos desta revisão para apresentar evidências científicas recentes que refletem esses avanços na compreensão da migrânea e de outras cefaleias na infância e adolescência, sem perder de vista a aplicabilidade desses novos conceitos na prática clínica diária. A partir de dados inéditos do Projeto Atenção Brasil, um amplo estudo epidemiológico sobre cefaleia, saúde mental e hábitos em crianças e adolescentes brasileiros, os autores discutem os principais resultados recentemente publicados por eles na literatura sobre epidemiologia das cefaleias primárias, exposições no período pré-natal e risco de cefaleia crônica diária na infância, agregação familiar das cefaleias primárias e síndromes periódicas da infância. Um resumo sobre tratamento sintomático e profilático da migrânea na infância é apresentado ao final, bem como as implicações desses avanços para a prática clínica diária.