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Published on: June 2, 2014
Primary headaches in preschool age children: clinical study and follow-up in 163 patients
P A Battistella1, E Fiumana, M Binelli
1Department of Paediatrics, University of Padova, Padova, Italy. battist@pediatria.unipd.it
Insights
Pediatric headaches are increasingly common. Preschoolers experience shorter, less symptomatic headaches, predominantly tension-type, unlike pubertal patients, highlighting diagnostic challenges in young children.
Area of Science:
- Pediatric Neurology
- Headache Medicine
Background:
- Headache frequency is rising in preschool-aged children.
- Limited research exists on the clinical characteristics of headaches in this age group.
Purpose of the Study:
- To evaluate and compare clinical features of headaches in preschool-aged children versus pubertal children.
- To assess the adequacy of current headache classification criteria for juvenile populations.
Main Methods:
- Retrospective analysis of 243 pediatric patients.
- Patients divided into two groups: preschool-onset (Group 1) and pubertal-onset (Group 2).
- Comparison of demographic data, clinical features, and diagnosis between groups.
Main Results:
- Positive family history was a significant risk factor in both groups.
- Preschoolers (Group 1) had higher male prevalence, earlier onset, shorter duration, and fewer associated symptoms (photophobia, phonophobia, nausea) than pubertal patients (Group 2).
- Tension-type headache predominated in Group 1, while migraine was more prevalent in Group 2. Over 10% of Group 1 headaches were unclassifiable by International Headache Society criteria.
Conclusions:
- Headache presentation differs significantly between preschool and pubertal age groups.
- Current International Headache Society classification criteria are insufficient for diagnosing headaches in younger children.
- Further research is needed to refine diagnostic criteria for pediatric headaches.
Abstract:
Although headache frequency is increasing in preschool age children, an extensive evaluation of the clinical features in affected patients has yet to be achieved. This retrospective study examined 243 patients who were separately analysed in two distinct groups according to the age of onset and the age of first clinical evaluation. Group 1 included preschool age children, while Group 2 consisted of pubertal age patients. In all the patients the importance of a positive family history for headache as a risk factor was confirmed. In addition, when compared with Group 2, Group 1 showed greater male gender prevalence and earlier onset of the attacks. Regarding clinical features, in Group 1, compared with Group 2, the attack duration was shorter with lower symptom association such as photo- or phonophobia, nausea and no pain increase during physical activity. In the same group, tension-type headache was the predominant diagnosis, in contrast to the high migraine prevalence of Group 2. This study also showed that the International Headache Society 1988 classification criteria are not fully adequate for juvenile headaches. In fact, the headaches of more than 10% of patients in Group 1 still remained unclassifiable, while those of all the subjects in Group 2 were properly classifiable.