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EDITORIAL
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Pediatric Headache: A basket of maladies


1 Department of Neurology, Lady Hardinge Medical College, New Delhi, India
2 Department of Pediatrics (Neurology Division), Lady Hardinge Medical College, New Delhi, India

Date of Submission15-Dec-2020
Date of Acceptance11-Apr-2021
Date of Web Publication11-Oct-2021

Correspondence Address:
Suvasini Sharma,
Department of Pediatrics (Neurology Division), Lady Hardinge Medical College, New Delhi.
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpn.JPN_319_20

 




How to cite this URL:
Garg D, Sharma S. Pediatric Headache: A basket of maladies. J Pediatr Neurosci [Epub ahead of print] [cited 2021 Nov 28]. Available from: https://www.pediatricneurosciences.com/preprintarticle.asp?id=327908




Headache is the most frequent neurological disorder in the general population including children. It is among the most common reasons for outpatient and emergency visits. Headaches in children raise parental concerns, as the underlying cause of headache may range from entirely benign to life-threatening. The overall mean prevalence of headache in the pediatric population is 50% as per population-based studies.[1] By the age of 3 years, nearly 3–8% children have already reported a headache, and by the age of 18 years, up to 82% of teenagers may experience a headache.[2] Headaches among children have significant impact on quality of life.[3]

There are several hospital-based studies on pediatric headache from India. In a study of 100 children from 3 to 14 years of age, children with primary headache were enrolled and those with secondary headaches were excluded.[4] The most common primary headache in this study was migraine (46%) and tension type headache (31%).[5] Other causes of primary headache included mixed (7%), psychogenic (8%), and non-specific headaches (8%). Migraine dominated among female adolescent children. In another tertiary center-based cross-sectional study in Delhi among 43 children between the ages of 3 to 18 years, 60.5% had migraine, 25.6% had tension type headache, and 9.3% had non-specific headache.[6] Interestingly, none of the children in this study had headache secondary to an ophthalmological problem.[5] In a cross-sectional study among school going children in Indore, 500 children between the age of 7 and 14 years were enrolled.[7] The prevalence of recurring headache in this study was 25.5%. Of the children enrolled, 15.5% had migraine, 5% had tension type headache, and 5% had mixed symptoms of both migraine and tension type headache. Aggravating risk factors included increasing age, presence of family history of headaches, female sex, and “sensitive” personality traits. Days when headache was likely to occur concurred with science and mathematics test dates and days following the weekend.

Secondary headaches among children have also been reported to varying extents. In the present study from Himachal Pradesh, a secondary cause was identified in 25% children, most commonly due to refractive error, sinusitis, otitis media, and dental caries. Of children with secondary headache, 40% presented within 1 month of onset, unlike primary headaches which has a longer onset-to-presentation time. Certain clinical features have been described as red flags towards consideration of a secondary cause of headache: headache of less than 1-month duration, presence of seizures, absence of family history of migraine, thunderclap/ worst headache, occipital location, headache leading to awakening from sleep etc.[8] Headache of less than 1-month duration had a higher likelihood of being associated with a surgical lesion in a retrospective series of 28 cases.[9] However, more data are certainly necessary on strength of association of this clinical feature as a pointer towards secondary headaches. In terms of family history, only 15% of children in the current study harbored the same. Traditionally considered as a red flag for headache, the absence of family history should not be used to automatically commit the patient to neuroimaging. Family history may not be obtained due to lack of appropriate recognition or diagnosis among the parents, adoption, or the loss of a parent.

In the present study, 65% of patients with migraine reported exertional activity as a trigger. Triggers for pediatric migraine have also been variously identified. Among children with tension type headache, 65% reported lack of sleep as well as anxiety as a trigger. In a study from Delhi, stress was found to be a migraine trigger in a majority of the children, along with environmental noise and lack of sleep.[10] In another study of retrospective nature from Eastern India among 200 children, triggers identified included environmental triggers such as sun exposure, humidity, smoke, noise as well as stress related to school.[11]

Despite a number of studies emerging from India, certainly, further prospective and population-based studies on pediatric migraine related to clinical aspects are warranted. Such studies must necessarily include long-term outcomes and adverse impacts on quality-of-life parameters among Indian children, arising consequent to this common yet multidimensional malady.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol 2010;52:1088-97.  Back to cited text no. 1
    
2.
Antonaci F, Voiticovschi-Iosob C, Di Stefano AL, Galli F, Ozge A, Balottin U. The evolution of headache from childhood to adulthood: a review of the literature. J Headache Pain 2014;15:15.  Back to cited text no. 2
    
3.
Powers SW, Patton SR, Hommel KA, Hershey AD. Quality of life in childhood migraines: clinical impact and comparison to other chronic illnesses. Pediatrics 2003;112:e1-5.  Back to cited text no. 3
    
4.
Dalal P, Singh J. Recurrent headache in children. J Indian Med Assoc 2014;112:106-7, 109.  Back to cited text no. 4
    
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XXX. Pattern of recurrent pediatric headache: a cohort of 100 children. J Pediatr Neurosci2020. In press.   Back to cited text no. 5
    
6.
Mishra D, Sharma A, Juneja M, Singh K. Recurrent headache in pediatric outpatients at a public hospital in delhi. Indian Pediatr 2013;50:775-8.  Back to cited text no. 6
    
7.
Mehta S. Study of various social and demographic variables associated with primary headache disorders in 500 school-going children of central India. J Pediatr Neurosci 2015;10:13-7.  Back to cited text no. 7
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8.
Yonker M. Secondary headaches in children and adolescents: what not to miss. Curr Neurol Neurosci Rep 2018;18:61.  Back to cited text no. 8
    
9.
Medina LS, Pinter JD, Zurakowski D, Davis RG, Kuban K, Barnes PD. Children with headache: clinical predictors of surgical space-occupying lesions and the role of neuroimaging. Radiology 1997;202:819-24.  Back to cited text no. 9
    
10.
Mishra D, Sharma A. Triggers of migraine in children at a public hospital in India. Springerplus 2012;1:45.  Back to cited text no. 10
    
11.
Chakravarty A, Mukherjee A, Roy D. Trigger factors in childhood migraine: a clinic-based study from eastern India. J Headache Pain 2009;10:375-80.  Back to cited text no. 11
    




 

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