Evaluation of the Etiology, Clinical Presentation, Findings and Prophylaxis of Children with Headache

Objectives: A headache is prevalent in childhood and constitutes a significant part of outpatient applications. This study aimed to evaluate the results of etiology, clinical features, examination results, prophylactic treatment and follow-up in patients with a headache.
Methods: Between January 2017 and December 2018, the files of the patients with the complaint of headache were reviewed retrospectively in this study. A headache was classified according to the International Headache Society (IHS) criteria.
Results: In this study, 350 patients aged between 3-17 years old and the mean age of 11.2±2.7 with a headache were included; 212 (60.6%) of them was female and 138 (39.4%) of them was male. The rate of a primary headache was higher in females than in males (p=0.004). The headache causes were a migraine in 51.1%, tension-type headache in 32.3%, secondary in 13.4%, and not classified in 3.1%. The mean age of the patients with a primary headache was significantly higher than patients with a secondary headache (p<0.001). The most common trigger factor was insomnia (52.7%). Abnormal physical/neurological signs and symptoms were detected in 17 (9.49%) patients. Cranial magnetic resonance imaging (MRI) examination was performed in 121 (34.5%) patients. Abnormal findings were found in 35 (28.9%) of these. In this study, 33 patients underwent electroencephalography (EEG); none of the had an epileptiform abnormality. Flunarizine (23.2%) and cyproheptadine (7.5%) were the most administered prophylactic treatments. It was observed that all patients who had prophylaxis and who had come to control had a significant decrease in headaches.
Conclusion: The cause of childhood headaches is mostly migraine and tension-type headache. As long as there is no abnormality in the history and neurological examination, neuroimaging studies are not required in the routine evaluation of patients with a headache. Prophylactic treatment increases the quality of life in selected cases.

Baþ Aðrýsý Olan Çocuk Hastalarýmýzýn Etiyoloji, Klinik, Tetkik ve Proflaksi Açýsýndan Deðerlendirilmesi

Amaç: Baþ aðrýsý, çocukluk çaðýnda çok sýktýr ve poliklinik baþvurularýnýn önemli bir kýsmýný oluþturur. Bu çalýþmanýn amacý, baþ aðrýsý yakýnmasýyla baþvuran hasta¬larda etiyoloji, klinik özellikler, tetkik sonuçlarý, proflaktik tedavi ve izlem sonuçlarýný deðerlendirmektir.
Yöntem: Ocak 2017 ile Aralýk 2018 tarihleri arasýnda baþ aðrýsý yakýnmasýyla baþvuran hastalarýn dosyalarý retrospektif olarak incelendi. Baþ aðrýlarý, Uluslararasý Baþ Aðrýsý Derneði kriterlerine göre sýnýflandýrýldý.
Bulgular: Yaþlarý 3-17 arasýnda, yaþ ortalamalarý 11,2±2,7 yýl olan 212 kýz (%60,6), 138 erkek (%39,4) toplam 350 baþ aðrýsý olan hasta dahil edildi. Kýz cinsiyette birincil baþ aðrýsý oraný erkek cinsiyete göre daha yüksek oranda bulundu (p=0,004). Baþ aðrýsý nedenleri %51,1 hastada migren, %32,3’ünde gerilim tipi baþ aðrýsý, %13,4 hastada ikincil, %3,1’isinde ise sýnýflandýrýlamayandý. Birincil baþ aðrýsý olanlarýn yaþ ortalamasý, ikincil baþ aðrýsý olanlara göre istatistiksel olarak yüksekti (p<0,001). En sýk tetikleyici faktör uykusuzluktu (%52.7). Hastalarýn 17 (%9,49)‘sinde anormal fizik/nörolojik bulgu saptandý. Kranial manyetik rezonans görüntüleme incelemesi 121 (%34,5) hastaya yapýlmýþtý. Bunlarýn 35 (%28,9)’inde anormal bulgular saptandý. Toplamda 33 hastaya elektroensefalogtrafi çekildi, hiçbirinde epileptiform anormallik saptanmadý. Proflaktik tedavi olarak en çok flunarizin (%23,2) ve siproheptadin (%7,5) verildi. Proflaksi baþlanan ve kontrole gelen tüm hastalarýn baþ aðrýlarýnda belirgin azalma olduðu gözlendi.
Sonuç: Çocukluk çaðý baþ aðrýlarýnýn nedeni çoðunlukla migren ve gerilim tipi baþ aðrýsýdýr. Anamnez ve nörolojik muayenede anormallik olmadýðý sürece baþ aðrýlý hastalarýn rutin deðerlendirmesinde nörogörüntüleme çalýþmalarýna gerek yoktur. Seçilmiþ vakalarda verilen proflaktik tedavi hayat kalitesini arttýr. (SETB-2018-12-183)