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Published on: June 2, 2014
Recurrent and chronic headaches in children below 6 years of age
Vincenzo Raieli1, Mario Eliseo, Eleonora Pandolfi
1Child Headache Center, Division of Child Neuropsychiatry, GF Ingrassia Hospital, A.U.S.L. n. 6, Palermo, Italy. vinzi.raielk@inwind.it
Insights
In young children under 6, migraine is the most common headache. However, secondary causes and dangerous headaches are more prevalent than in older children, with primary stabbing headache also being common.
Area of Science:
- Pediatric Neurology
- Headache Medicine
Background:
- Headache diagnosis in pre-school children presents unique challenges.
- Understanding headache subtypes in this age group is crucial for appropriate management.
Purpose of the Study:
- To determine the frequency of headache subtypes in children under 6 years old.
- To compare headache prevalence in this group with school-aged children.
Main Methods:
- Retrospective review of medical records of children under 6 years old.
- Headache classification based on International Headache Society (IHS) criteria (2004).
- Exclusion criteria included fewer than three headache attacks or less than 15 days of daily headache.
Main Results:
- Migraine was the most frequent diagnosis (35.2%).
- Higher prevalence of secondary headaches, including post-traumatic (17.1%) and dangerous headaches (2.85%), was observed compared to school-aged children.
- Primary stabbing headache showed a high prevalence in this age group (12.4%).
Conclusions:
- Migraine is common in pre-schoolers, but secondary and dangerous headaches are more frequent than in older children.
- Post-traumatic headaches and primary stabbing headaches are notable in this young population.
- Early diagnosis and management are essential for potentially serious headache conditions in young children.
Abstract:
The objective was to determine the frequency of headache subtypes, according to International Headache Society (IHS) criteria, in a population of children below 6 years visiting a Center for Diagnosis and Treatment of Headache in Youth. Medical records of the children below 6 years at their first visit, admitted for headache between 1997 and 2003, were studied. Headache was classified according to the IHS criteria 2004. Children with less than three headache attacks or less than 15 days of daily headache were excluded. We found 1598 medical records of children who visited our Headache Center in the study period. One hundred and five (6.5%) were children younger than 6 years. The mean age at the first medical control was 4.8+/-1.3 years (range 17-71 months). There were 59 males (56.1%) and 46 females (43.9%). The mean age at onset of headaches was 4.3 years (range 14-69 months). According to the IHS criteria we found 37 cases (35.2%) with migraine, 19 cases (18%) with episodic tension headache, 5 cases (4.8%) with chronic daily headache, 13 cases (12.4%) with primary stabbing headache, 18 cases (17.1%) with post-traumatic headache, 7 cases (6.6%) with other non-dangerous secondary headaches (otorhinolaryngological diseases, post-infectious headaches), 3 cases (2.85%) with dangerous headaches (Arnold-Chiari type 1 malformation, brain tumour) and 9 cases (8.6%) with unclassifiable headaches. Six children (5.7%) reported more than one headache subtype. The prevalence of dangerous headaches was higher than those in school age (chi(2)=4.70, p<0.05). Our study shows some differences in headaches in this population vs. school children. In fact at this age migraine is the most common headache, but we also found an increase of secondary causes among the chronic/recurrent and daily headaches, especially posttraumatic disorders and potentially dangerous headaches. Finally our study shows the highest prevalence of the idiopathic stabbing headache in pre-school children in comparison with other ages.
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