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ÇOCUKLUK ÇAĞI BAŞ AĞRILARI: NÖROGÖRÜNTÜLEMENİN TANIYA KATKISI VAR MI?

Year 2022, Volume: 29 Issue: 3, 438 - 445, 30.09.2022
https://doi.org/10.17343/sdutfd.1128938

Abstract

Amaç
Baş ağrısı, çocukluk çağında sık görülen bir yakınmadır.
Genellikle etiyolojide migren, gerilim tipi baş ağrısı
gibi benign sebepler saptanmakla birlikte, altta yatan
ciddi bir patolojiyi atlama endişesi ile hastalara kraniyal
görüntüleme sıklıkla yapılmaktadır. Bu çalışmada,
çocuklarda görülen baş ağrılarının etiyolojisini ve klinik
özelliklerini değerlendirmek, görüntüleme yöntemlerinin
tanıya olan katkısını belirlemek istedik.
Gereç ve Yöntem
Bu retrospektif çalışmaya, Süleyman Demirel Üniversitesi
Tıp Fakültesi Çocuk Nörolojisi Polikliniği’ne,
2019-2022 yılları arasında, baş ağrısı yakınması ile
başvuran hastalar dahil edildi. Baş ağrısı ile ilgili bilgiler
(sıklık, süre, tipi, karakteri, şiddeti, lokalizasyonu,
eşlik eden bulgular) alındı, kraniyal görüntüleme
yapılan hastaların sonuçları kayıt edildi. Baş ağrıları,
Uluslararası Baş Ağrısı Cemiyeti’nin kriterlerine göre
sınıflandırıldı.
Bulgular
Yaşları 2-18 arasında değişen, % 64,5’i kız olan, 234
hasta dahil edildi. Yaş ortalaması 12,56 yıl idi. Hastaların
% 68,4’ü birincil baş ağrısı tanısı aldı; gerilim
tipi baş ağrısı % 46,2, migren % 31,2 ve diğer birincil
baş ağrısı sebepleri % 22,5 oranlarında görüldü. İkincil
baş ağrıları arasında %79,7 oranında kraniyum,
boyun, gözler, kulaklar, burun, sinüsler, ağız ya da diğer
yüz veya kraniyal yapıların bozukluklarına bağlı
başağrısı görüldü ve en sık sebep sinüzit olarak belirlendi.
Hastaların % 66,7’sine kraniyal görüntüleme
yapıldı, % 51.9’u anormal saptandı. Anormal olarak
değerlendirilen görüntüleme sonuçlarının %14,1’i tesadüfen
saptanan, potansiyel klinik önemi olan serebral
anormallikler; %10,3’ü tesadüfen saptanan, klinik
önemi olmayan bulgulardı. Bu hastaların tedavileri
görüntüleme sonucu ile değişmedi. %25’i de baş ağrısı
ile ilişkili ekstraserebral anormallik olarak değerlendirildi.
Sadece bir hastanın sonucu baş ağrısı ile
ilişkilendirildi, sinus ven trombozu tanısı aldı ve tedavisi
düzenlendi.
Sonuç
Bu çalışmada, çocukluk çağı baş ağrılarının büyük
çoğunluğunun benign olduğu, etiyolojide ilk sırayı
gerilim tipi baş ağrısı, enfeksiyon ve migrenin yer aldığı,
görüntüleme yöntemlerinin tanıya katkısının az
olduğu görüldü. Baş ağrısı ile başvuran hastalarda,
ayrıntılı bir klinik değerlendirilme sonrasında etiyolojinin
aydınlatılabileceği, görüntüleme yöntemlerinin seçilmiş
vakalarda yararlı olabileceği sonucuna varıldı.

References

  • 1. Rossi R, Versace A, Lauria B, et al. Headache in the pediatric emergency department: A 5-year retrospective study. Cephalalgia 2018;38(11):1765-72.
  • 2. Ekici A, Yimenicioğlu S, Carman K. Kocak O, Yarar C, Yakut A. Evaluation of headache in children: a retrospective study. EuRJ 2015;1(3);136-40.
  • 3. Yılmaz Ü, Çeleğen M, Yılmaz TS, Gürçınar M, Ünalp A. Childhood headaches and brain magnetic resonance imaging findings. Eur J Paediatr Neurol 2014;18(2):163-70.
  • 4. Köken ÖY, Dünya B, Çelik A, Yılmaz D, Kurt AN. Pediatric Headaches: One year of Observation from A Tertiary Center. Türkiye Çocuk Hast Derg 2021; 15(6): 488-493.
  • 5. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1–211.
  • 6. Gurkas E, Karalok ZS, Taskın BD, Aydogmus U, Yılmaz C, Bayram G. Brain magnetic resonance imaging findings in children with headache. Arch Argent Pediatr 2017;115:349-55.
  • 7. Raucci U, Della Vecchia N, Ossella C, Paolino MC, Villa MP, Reale A, et al. Management of Childhood Headache in the Emergency Department. Review of the Literature. Front Neurol 2019;23(10): 886.
  • 8. Kelly M, Strelzik J, Langdon R, DiSabella M. Pediatric headache: overview. Curr Opin Pediatr 2018;30(6):748-54.
  • 9. Dao JM, Qubty W. Headache Diagnosis in Children and Adolescents. Curr Pain Headache Rep 2018;22(3):17.
  • 10. Rho YI, Chung HJ, Suh ES, et al. The role of neuroimaging in children and adolescents with recurrent headaches e multicenter study. Headache 2011;51(3):403e8.
  • 11. P.F. Streibert, W. Piroth, M. Mansour, et al. Magnetic resonance imaging of the brain in children with headache: the clinical relevance with modern acquisition techniques. Clin Pediatr 2011;50 (12):1134-39.
  • 12. J. Maytal, R.S. Bienkowski, M. Patel, L. Eviatar. The value of brain imaging in children with headaches. Pediatrics 1995;96(31):413-16.
  • 13. Lewis DW, Dorbad D. The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache 2000;40:629-32.
  • 14. Schwedt TJ, Guo Y, Rothner AD. "Benign" imaging abnormalities in children and adolescents with headache. Headache 2006;46(3):387-98.
  • 15. E. Bayram, Y. Topcu, P. Karaoglu, et al. Incidental white matter lesions in children presenting with headache. Headache 2013,53(6):970-76.
  • 16. Kim BS, Illes J, Kaplan RT, Reiss A, Atlas SW. Incidental findings on pediatric MR images of the brain. Am J Neuroradiol 2002;23(10):1674-77.

PEDIATRIC HEADACHES: DOES NEUROIMAGING CONTRIBUTE TO DIAGNOSIS?

Year 2022, Volume: 29 Issue: 3, 438 - 445, 30.09.2022
https://doi.org/10.17343/sdutfd.1128938

Abstract

Objective
Headache is a common complaint in childhood.
While the etiology is usually benign, such as migraine
or tension-type headache, cranial imaging is often
performed on patients to identify any missed or serious
underlying pathology. In the present study we assess
the etiology and clinical characteristics of headaches
in children and establish the diagnostic contribution of
imaging methods.
Material and Method
This retrospective study included patients who
presented with headaches to the Pediatric
Neurology Outpatient Clinic of Süleyman Demirel
University Faculty of Medicine between 2019 and
2022. Headache information (frequency, duration,
type, characteristics, intensity, localization, and
accompanying findings) was obtained, and the cranial
imaging results of patients were recorded. Headaches
were classified according to the criteria established by
the International Headache Society.
Results
The study included 234 patients aged 2–18 years
with a mean age of 12.56 years, of which 64.5% were
female. The diagnosis was primary headaches in
68.4% of the patients, with tension-type headaches
in 46.2%, migraine in 31.2%, and other primary
headache causes in 22.5%. Among the secondary
headaches, disorders of the cranium, neck, eyes,
ears, nose, sinuses, teeth or other cervical structures
accounted for 79.7%, with the most common cause
being sinusitis. Cranial imaging was performed on
66.7% of the patients, of which 51.9% were identified
with abnormal findings. 14.1% of the imaging
results evaluated as abnormal were incidentally
detected cerebral abnormalities with potential clinical
significance; 10.3% were findings that were found
incidentally and had no clinical significance. The
treatment of these patients did not change with the
imaging result. Another 25% were evaluated as
extracerebral abnormality associated with headache.
Only one patient's outcome was associated with
headache. The patient was diagnosed with sinus vein
thrombosis and the treatment was arranged.
Conclusion
The majority of childhood headaches identified in
the present study were found to be benign, with the
leading causes being tension-type headache, infection
and migraine, and imaging methods were found to
be of little diagnostic benefit. It was concluded that
a detailed clinical assessment of patients presenting
with headaches could clarify the etiology, while
imaging methods may be useful in selected cases.

Thanks

Thanks to Dr. Veysel Atilla Ayyıldız and Dr. Kübra Boztepe for their help in data analysis and evaluation of cranial images.

References

  • 1. Rossi R, Versace A, Lauria B, et al. Headache in the pediatric emergency department: A 5-year retrospective study. Cephalalgia 2018;38(11):1765-72.
  • 2. Ekici A, Yimenicioğlu S, Carman K. Kocak O, Yarar C, Yakut A. Evaluation of headache in children: a retrospective study. EuRJ 2015;1(3);136-40.
  • 3. Yılmaz Ü, Çeleğen M, Yılmaz TS, Gürçınar M, Ünalp A. Childhood headaches and brain magnetic resonance imaging findings. Eur J Paediatr Neurol 2014;18(2):163-70.
  • 4. Köken ÖY, Dünya B, Çelik A, Yılmaz D, Kurt AN. Pediatric Headaches: One year of Observation from A Tertiary Center. Türkiye Çocuk Hast Derg 2021; 15(6): 488-493.
  • 5. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1–211.
  • 6. Gurkas E, Karalok ZS, Taskın BD, Aydogmus U, Yılmaz C, Bayram G. Brain magnetic resonance imaging findings in children with headache. Arch Argent Pediatr 2017;115:349-55.
  • 7. Raucci U, Della Vecchia N, Ossella C, Paolino MC, Villa MP, Reale A, et al. Management of Childhood Headache in the Emergency Department. Review of the Literature. Front Neurol 2019;23(10): 886.
  • 8. Kelly M, Strelzik J, Langdon R, DiSabella M. Pediatric headache: overview. Curr Opin Pediatr 2018;30(6):748-54.
  • 9. Dao JM, Qubty W. Headache Diagnosis in Children and Adolescents. Curr Pain Headache Rep 2018;22(3):17.
  • 10. Rho YI, Chung HJ, Suh ES, et al. The role of neuroimaging in children and adolescents with recurrent headaches e multicenter study. Headache 2011;51(3):403e8.
  • 11. P.F. Streibert, W. Piroth, M. Mansour, et al. Magnetic resonance imaging of the brain in children with headache: the clinical relevance with modern acquisition techniques. Clin Pediatr 2011;50 (12):1134-39.
  • 12. J. Maytal, R.S. Bienkowski, M. Patel, L. Eviatar. The value of brain imaging in children with headaches. Pediatrics 1995;96(31):413-16.
  • 13. Lewis DW, Dorbad D. The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache 2000;40:629-32.
  • 14. Schwedt TJ, Guo Y, Rothner AD. "Benign" imaging abnormalities in children and adolescents with headache. Headache 2006;46(3):387-98.
  • 15. E. Bayram, Y. Topcu, P. Karaoglu, et al. Incidental white matter lesions in children presenting with headache. Headache 2013,53(6):970-76.
  • 16. Kim BS, Illes J, Kaplan RT, Reiss A, Atlas SW. Incidental findings on pediatric MR images of the brain. Am J Neuroradiol 2002;23(10):1674-77.
There are 16 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles
Authors

Müjgan Arslan 0000-0002-0486-3431

Publication Date September 30, 2022
Submission Date June 14, 2022
Acceptance Date August 31, 2022
Published in Issue Year 2022 Volume: 29 Issue: 3

Cite

Vancouver Arslan M. PEDIATRIC HEADACHES: DOES NEUROIMAGING CONTRIBUTE TO DIAGNOSIS?. Med J SDU. 2022;29(3):438-45.

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