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Published on: June 2, 2014
Childhood primary stabbing headache: A double center study
Gabriele Monte1, Laura Papetti1, Fabiana Ursitti1
1Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy.
Insights
Childhood primary stabbing headache (PSH) characteristics vary, with many experiencing longer stab durations than current criteria allow. Associated migraine and episodic syndromes suggest a potential common link requiring further study.
Area of Science:
- Neurology
- Pediatrics
- Headache Medicine
Background:
- Primary stabbing headache (PSH) is an idiopathic disorder causing brief, localized head pain.
- The study evaluated childhood PSH characteristics against the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria.
- Investigated associations between PSH, migraine, and episodic syndromes in children.
Purpose of the Study:
- To characterize childhood primary stabbing headache (PSH).
- To assess the suitability of ICHD-3 criteria for diagnosing PSH in children.
- To explore the relationship between PSH, migraine, and episodic syndromes in pediatric patients.
Main Methods:
- Retrospective study of 60 pediatric patients diagnosed with PSH at two headache clinics (2016-2022).
- Standardized headache history and neurological examinations were performed.
- Diagnosis of PSH was based on ICHD-3 criteria.
Main Results:
- Median age at onset was 8 years, with stab durations varying up to 30 minutes.
- Over 78% had a family history of primary headaches, particularly migraine.
- 38% of patients met probable PSH criteria due to stab duration exceeding 3 seconds, and 43% had associated episodic syndromes.
Conclusions:
- Childhood PSH exhibits diverse features, with stab durations often exceeding current ICHD-3 criteria, suggesting a need for diagnostic adjustments.
- A high prevalence of associated migraine and episodic syndromes indicates a potential shared pathophysiology.
- PSH and migraine may represent a spectrum of the same disorder, warranting further investigation with larger, longitudinal studies.
Background:
Primary stabbing headache (PSH) is an idiopathic headache disorder characterized by head pain occurring as a transient and localized single stab or a series of stabs. The present study aimed to examine the characteristics of childhood PSH and whether they fit the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. We also investigated the association with migraine and episodic syndromes.
Methods:
In this retrospective study, we included 60 patients seen at two headache clinics (Rome and Bari) between 2016 and 2022. A headache-focused history was obtained. All patients had normal neurological examination. PSH was defined according to ICHD-3 criteria.
Results:
Twenty-three patients were male (38%) and median (range) age at disease onset was 8 (3-17) years. Stabs recurred with irregular frequency and their duration varied from a few seconds up to 30 minutes. Stabs were located in different head regions. Twenty-five patients (42%) underwent neuroimaging exams. Five children reported a limitation of daily activities and none had a chronic pattern. Forty-seven patients (78%) reported a family history of primary headache, especially migraine, and forty-three had episodic syndromes (i.e. infantile colic, benign paroxysmal vertigo, motion sickness, recurrent abdominal pain, cyclic vomiting). Twenty patients had an associated primary headache: 16 suffered from migraine and four suffered from tension type-headache. According to ICHD-3 criteria, thirty-one patients had a diagnosis of probable PSH as a result of a duration of stabs longer than a few seconds (>3 seconds).
Conclusions:
Features of childhood PSH can vary widely. As seen in previous studies, several patients reported a stab duration longer than a few seconds and this might suggest that current ICHD-3 criteria may need adjustments to be suitable for children. High frequency of associated migraine and episodic syndromes could suggest a common pathophysiological mechanism between PSH and migraine. We can hypothesize that PSH and migraine attacks may be part of a spectrum of the same disease, although further evidence is needed. Larger studies with long-term follow-up are needed to improve understanding of this condition.
