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Secondary headache in an outpatient headache clinic at a pediatric tertiary care facility
Tsukasa Higuchi1,2, Ayako Kanai1, Keiko Okita1
1Department of General Pediatrics, Nagano Children's Hospital, Azumino, Japan.
Insights
Pediatric secondary headaches are often linked to psychiatric and homeostatic disorders, particularly in adolescents. Autism spectrum disorder (ASD) is a common comorbidity, requiring careful developmental assessment in young patients.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Developmental Pediatrics
Background:
- Secondary headaches in children are multifactorial, with limited data on outpatient populations.
- Existing research predominantly focuses on emergency department visits for secondary headaches.
Purpose of the Study:
- To investigate the characteristics and diagnoses of pediatric patients presenting with secondary headaches in an outpatient setting.
- To identify common comorbidities and demographic factors associated with secondary headaches in children.
Main Methods:
- Retrospective review of medical records for patients visiting an outpatient headache clinic.
- Inclusion criteria: new patients diagnosed with secondary headache between May 2022 and October 2023.
Main Results:
- 39% of patients (27/68) were diagnosed with secondary headache.
- Psychiatric disorders (social anxiety disorder; SAD) and homeostatic disorders (orthostatic dysregulation; OD) were the most frequent diagnoses.
- Autism spectrum disorder (ASD) was a significant comorbidity (18 patients), with some diagnosed post-headache visit.
Conclusions:
- Social anxiety disorder (SAD) and autism spectrum disorder (ASD) are highly prevalent in pediatric secondary headache outpatients.
- Adolescent age group is significant, coinciding with the onset of orthostatic dysregulation (OD).
- Developmental characteristics, especially in adolescents, require careful consideration in pediatric secondary headache evaluations.
Background:
Headaches in children are caused by a variety of factors. Despite the numerous reports on secondary headache in the emergency department, details on pediatric headache outpatients are scarce.
Methods:
We retrospectively reviewed the medical records of patients who first visited our outpatient headache clinic between May 2022 and October 2023 and were considered to have secondary headache.
Results:
Twenty-seven of 68 patients (39%) were diagnosed as having secondary headache as the main illness. The gender breakdown of 20 boys and 7 girls represented a significant difference. Patient age range was 5-17 years (median: 13 years and 8 months), and a family history of headache was noted in 20 patients (74%). Headache frequency was described as "almost daily" in 18 patients (67%). The main diagnosis of secondary headache was psychiatric disorders (social anxiety disorder; SAD) in 13 patients, homeostatic disorders (orthostatic dysregulation; OD) in 9 patients, facial organ-related headache (FORH) in 3 patients, and nonvascular intracranial disease in 2 patients. Comorbidities included autism spectrum disorder (ASD) in 18 patients and school refusal (SR) in 8 patients. Nine of the ASD patients were diagnosed after their headache outpatient visit.
Conclusion:
Our analysis of secondary headache patients in a tertiary facility revealed that roughly half of the patients had SAD, all of whom harbored ASD as a comorbidity. Many of the patients were adolescents, which coincided with the age of OD onset. When examining pediatric secondary headache patients, extra attention is warranted to developmental characteristics, particularly those of adolescents.
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