Pediatric Headache and Seizures

Headache Is a Common Aura in Patients with Generalized Seizures

Background and Purpose

Although aura in epilepsy is usually considered as a phenomenon in patients with focal seizures, headache can occur as an aura or solitary epileptic symptom in patients with generalized seizures.

Methods

We performed a 14-year retrospective study of patients with generalized seizures and analyzed the proportion and characteristics of patients with auras including headache.

Results

Among the 102 patients diagnosed with generalized seizures, aura was reported in 45 patients and headache was the most common aura in 26 patients. The age of onset of seizures was significantly lower in patients with headache as an aura than in patients without headache (14.8±3.8 vs. 24.7±16.2; p=0.003).

Conclusions

Our study showed that headache was the most common aura in patients with generalized seizures and patients with a younger age of onset of seizures were more likely to experience headache as an aura in these patients.

The Prevalence of Headache Disorders in Children and Adolescents in Istanbul: A School-Based Study

BACKGROUND

Headache among children and adolescents is an important health problem. In this school-based epidemiological study conducted in Istanbul, we aimed to reveal the frequency of headaches in this population, define the risk factors associated with headaches, and establish the effect of headaches on the quality of life in this population.

METHODS

The child and adolescent versions of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation structured questionnaire were conducted in 30 schools in Istanbul. The diagnosis was made based on the International Classification of Headache Disorders III-(ICHD-3) beta version. Risk factors associated with headaches were analyzed in a binary logistic regression model.

RESULTS

Among the 5944 students (boys = 3011 [50.7%], girls 2933 [49.3%]) who completed the survey and were enrolled in this study, 3354 (56.4%) reported a headache ever. The prevalence of headaches was significantly higher in girls (62.6% vs. 50.4%, P < 0.001). Migraine prevalence was found to be 5.2%, whereas tension-type headache (TTH) prevalence was 26.1%. Being a female, age, living on the European side, and headache history in the family were found to be associated with an increased risk of having a headache. Pupils with headaches reported that they missed an average of 0.5 ± 1.5 school days due to headaches.

CONCLUSION

TTH was found to be the most common headache syndrome in Istanbul metropolitan area. Considering the effect of headaches on school success and quality of life in childhood, it is clear that the correct diagnosis of headaches and careful handling of risk factors are crucial for this population.

Quality of life in children suffering from headaches: a systematic literature review

BACKGROUND

Headaches are the most common complaints among pediatric populations. Determining the cause and appropriate treatment for headaches may be challenging and costly, and the impact of headaches on the lives of patients and their families is not well understood.

OBJECTIVE

A systematic literature review was conducted to examine what PROMs are currently used, and to identify quality of life (QoL) concepts important to children suffering from headaches and any known determinants of QoL.

METHODS

Embase, Medline, Web of Science, CINAHL, EBSCOhost, PsychINFO, Cochrane CENTRAL and Google Scholar were searched from their inception through to June 2021. Studies investigating QoL, using a validated outcome measure in pediatric patients with headaches, were included. Relevant studies were identified through title and abstract screening and full text review by two independent reviewers. A citation review of included studies was performed. QoL concepts were extracted from the outcome measures that were used in each study to develop a preliminary conceptual model of QoL in children suffering from headaches. Determinants of QoL were also identified and categorized.

RESULTS

A total of 5421 studies were identified in the search. Title and abstract screening resulted in the exclusion of 5006 studies. Among the 415 studies included for full text review, 56 were eligible for final analysis. A citation review resulted in the addition of five studies. Most studies were conducted in high-income countries and included a patient-sample accordingly (n = 45 studies). Sixteen different PROMs were identified in the included studies, of which the PedsQL was used the most often (n = 38 studies). The most common health concepts reported were physical functioning (n = 113 items), social and psychological wellbeing (N = 117, n = 91 resp.). Twenty-five unique determinants of QoL were extracted from the included studies.

CONCLUSION

There is a need for a condition-specific PROM to facilitate the measurement of QoL outcomes in the pediatric headache population. A conceptual model was developed based on the findings from the health concepts. Findings from this review could be used for future qualitative interviews with pediatric patients with headaches to elicit and refine important QoL concepts.

Clinical use of child-friendly video head impulse test in dizzy children

OBJECTIVE

To investigate the high-frequency vestibular functions using a child-friendly video head impulse test and to classify vestibular symptoms using a standard nomenclature guideline in dizzy children.

MATERIALS AND METHODS

The video head impulse test with a remote camera was used in this study. The data of 40 dizzy children (7.30 ± 4.75 years) were analyzed retrospectively.

RESULTS

The high-frequency vestibulo-ocular reflex gains of 14 (35%) dizzy children in the study group were reduced, whereas the vestibulo-ocular reflex gains of 26 (65%) dizzy children were normal. Two of them had a dramatic reduction in vestibulo-ocular reflex gains on their affected SCCs, but no corrective saccades as their gazes had not been fixated on the target at the onset of head impulses. In dizzy children, the most common cause was inner ear malformation (15%) and the most common vestibular symptom was unsteadiness (25%).

CONCLUSION

The high-frequency vestibular function of the VOR in dizzy children, especially those suffering from IEM and unsteadiness, can be quickly screened using the vHIT device with the remote camera. However, clinicians should be careful during the interpretation of traces in the pediatric group.

Headache in Children and Adolescents

PURPOSE OF REVIEW

This article reviews the approach to a child or adolescent with headache, the criteria for common diagnoses, and the evidence base for treatments.

RECENT FINDINGS

The guidelines for acute and preventive treatment of migraine were updated in 2019. These guidelines summarize the available evidence and outline the questions that should be addressed in future research. The US Food and Drug Administration (FDA) approval of several new classes of drugs and devices to treat adult migraine in the past few years has resulted in ongoing or planned pediatric trials.

SUMMARY

Headache is a common symptom in children, and it is important to take a detailed history and perform a thorough physical examination to make the diagnosis. Nearly 1 in 10 children experience recurrent headaches due to migraine, which cause significant impairment in school performance and quality of life. The acute and preventive treatments that are currently available will help at least two-thirds of children with migraine, and several trials of new therapies offer hope for the future.