Features of Primary Chronic Headache in Children and Adolescents and Validity of Ichd 3 Criteria

Abstract

Introduction: Chronic headaches are not a rare condition in children and adolescents with negative effects on their quality of life. Our aims were to investigate the clinical features of chronic headache and usefulness of the International Classification of Headache Disorders 3rd edition (ICHD 3) criteria for the diagnosis in a cohort of pediatric patients.Methods: We retrospectively reviewed the charts of patients attending the Headache Center of Bambino Gesù Children and Insubria University Hospital during the 2010–2016 time interval. Statistical analysis was conducted to study possible correlations between: (a) chronic primary headache (CPH) and demographic data (age and sex), (b) CPH and headache qualitative features, (c) CPH and risk of medication overuse headache (MOH), and (d) CPH and response to prophylactic therapies. Moreover, we compared the diagnosis obtained by ICHD 3 vs. ICHD 2 criteriaResults: We included 377 patients with CPH (66.4% females, 33.6% males, under 18 years of age). CPH was less frequent under 6 years of age (0.8%; p < 0.05) and there was no correlation between age/sex and different CPH types. The risk to develop MOH was higher after 15 years of age (p < 0.05). When we compared the diagnosis obtained by ICHD 2 and ICHD 3 criteria we found a significant difference for the undefined diagnosis (2.6% vs. 7.9%; p < 0.05), while the diagnosis of probable chronic migraine was only possible by using the ICHD2 criteria (11.9% of patients; p < 0.05). The main criterion which was not satisfied for a definitive diagnosis was the duration of the attacks less than 2 h (70% of patients younger than 6 years; p < 0.005). Amitriptyline and topiramate were the most effective drugs (p < 0.05), although no significant difference was found between them (p > 0.05).Conclusion: The ICHD 3 criteria show limitations when applied to children under 6 years of age. The risk of developing MOH increases with age. Although our “real word” study shows that amitriptyline and topiramate are the most effective drugs regardless of the CPH type, the lack of placebo-controlled data and the limited follow-up results did not allow us to conclude about the drug efficacy.

The Many Faces of Medication‐Overuse Headache in Clinical Practice

“…In tertiary headache clinics, about 50% of patients also have medication overuse 17 . Overuse of acute medication is observed in all age groups with a slight predominance of female patients 16,18 . Within the pediatric cohort, MOH is estimated at a prevalence around 0.5% with a higher rate among girls 19‐21 .…”

Medication Overuse Withdrawal in Children and Adolescents does not Always Improve Headache: A Cross-Sectional Study

“…The sample was partially published in Papetti et al, 2019. [18] In particular, Among these patients, we selected those presenting with a personal history of medication overuse, de ned as regular use of abortive therapy: at least 10 days per month for ergotamine, triptans, opioids or combination-analgesic medication and 15 or more days per month for non-opioid analgesics (paracetamol, non-steroidal anti-in ammatory drug or acetylsalicylic acid). Overuse should have been carried on for at least 3 months.…”

“…[11] In pediatric patients, it is more commonly associated with chronic migraine (CM). [18] Non-steroid anti-in ammatory drugs (NSAIDs) are the class of drugs more often overused, followed by paracetamol and triptans. [16] Historically, the treatment of MOH includes two main strategies: a detoxi cation program with discontinuation of drugs overused, and initiation of pharmacological and nonpharmacological preventive therapy.…”

Associations between migraine occurrence and the effect of aura, age at onset, family history, and sex: A cross-sectional study

“…Episodes of migraine in children may have a shorter duration of attack with excellent recovery within a short duration and there is the possibility of bilaterally located pain. Moreover, the frequency or attacks in pre-pubertal patients could be extremely low [50,51], and the symptoms associated with headache, such as photophobia and phonophobia, are rarely mentioned by the young patient [50]. Thus, migraine in children may be difficult to diagnose and easily missed in an interview.…”