Headache in Children and Adolescents A Case Based

Approach

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Ishaq Abu-Arafeh • Aynur Özge
Editors

Headache in Children
and Adolescents
A Case-Based Approach
Editors
Ishaq Abu-Arafeh Aynur Özge
Royal Hospital for Sick Children Çiflikköy Kampusü
Glasgow Mersin University School of Medicine
Forth Valley Royal Hospital Mersin
Larbert Turkey
UK

ISBN 978-3-319-28626-6 ISBN 978-3-319-28628-0 (eBook)

DOI 10.1007/978-3-319-28628-0

Library of Congress Control Number: 2016949450

© Springer International Publishing Switzerland 2016

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Preface

In some children, headache is mild, infrequent and managed well at home by parents
without seeking medical advice. In other children, headache is severe, prolonged
and frequent and may represent a devastating disorder such as a brain tumour or a
difficult-to-treat primary headache. In between these two ends of the spectrum,
there are dozens of types of headache that cause misery to the children, provoke
concerns to the parents and bring dilemmas of diagnosis and management to medi-
cal practitioners. Therefore, headache is not a single disease with a single solution
but a constellation of many disorders in which head pain is the main presenting
complaint. It would be more appropriate to consider the condition in the context of
childhood “headaches” or “headache disorders”.
Each type of headache has its own specific characteristics, associated symptoms,
natural course and prognosis. On occasions, the borders between different headache
disorders can be blurred, and the symptoms may be shared among different head-
aches, creating a special challenge in making a definitive positive diagnosis and a
management plan. This book tries to address these issues. Authors of different chap-
ters bring in clinical cases, some to illustrate the typical features of common disor-
ders and suggest clear advice in management. Other chapters deal with more
complex clinical situations with complex interaction between the biological ele-
ments of the disease, the psychological influences on child and family and also the
social factors that may help or hinder the course of the disease.
In modern medical education, problem-based learning has become an important
interactive tool in which the readers will be engaged in case analysis and suggesting
differential diagnosis and treatment. In this book, we took a similar approach, trying
to make the dull and complex clinical scenarios more lively and more engaging. The
contributing authors of Headache İn Children and Adolescents: A Case-Based
Approach come from many parts of the world, and they are accomplished experts in
the field of childhood headache disorders. We are so grateful to each one of them for
sharing with us real cases from their own practices with some necessary modifica-
tions in order to protect the identities of their patients. Following the presentation of
patients’ stories, authors make analysis of the clinical history, make a diagnosis
based on the application of appropriate clinical criteria and suggest investigations as

v
vi Preface

clinically indicated. The authors use their clinical expertise to make suggestions for
management and where appropriate may involve professionals for different clinical
disciplines.
Headache İn Children and Adolescents: A Case-Based Approach is designed to
be an easy-to-use clinical resource with the busy clinicians in mind. It aims to help
practitioners treating children with headache in their daily practice. The readers will
notice that we kept theoretical knowledge on epidemiology, genetics, pathogenesis
and disease mechanisms and review of randomised trials to the minimum but at the
same time ensuring all statements, advice and treatment options to be evidence
based as much as possible and as soon as evidence is available. References are kept
to the minimum in order to avoid overwhelming the readers with uncertainties and
in order to keep the book user-friendly; all chapters are written to follow a similar
style so readers can find information quickly and when they need it. Advances in
information technology and digital publishing have helped us in taking this book
into a new era, allowing the publication of high-definition photos and also including
a video clip to demonstrate a clinical case.
This book could never be prepared if it wasn’t for Springer and Barbara Lopez-
Lucio, the developmental editor. We are grateful for her hard work and support.
Likewise, we are thankful to all of our professors, from whom we learned so much,
to our patients and their precious families and, lastly, to our spouses and our
children.

Glasgow, UK Ishaq Abu-Arafeh, MBBS, MD, MRCP, FRCPCH

Mersin, Turkey Aynur Özge, MD
20 March 2016
Contents

1 A Child with Infrequent Attacks of Migraine Without Aura . . . . . . . . . . 1

Ishaq Abu-Arafeh
2 A Child with Frequent Attacks of Migraine Without Aura . . . . . . . . . . . 5
Ishaq Abu-Arafeh
3 A Child with Chronic Migraine Without Aura . . . . . . . . . . . . . . . . . . . . . 9
Ishaq Abu-Arafeh
4 A Child with Infrequent Attacks of Migraine with Aura . . . . . . . . . . . . 15
Semih Ayta and Derya Uludüz
5 A Child with Frequent Attacks of Migraine with Aura . . . . . . . . . . . . . 19
Çiçek Wöber-Bingöl
6 A Child with Migraine with Intense Visual Aura/“Alice
in Wonderland Syndrome” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Ishaq Abu-Arafeh
7 A Child with Hemiplegic Migraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Ishaq Abu-Arafeh
8 A Child with Migraine with Brainstem Aura
or Basilar-Type Migraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Ishaq Abu-Arafeh
9 A Child with Infrequent Episodic Tension-Type Headache . . . . . . . . . . 39
Cristiano Termine, B. Bartoli, S. Crugnola, and U. Balottin
10 A Child with Frequent Episodic Tension-Type Headache . . . . . . . . . . . 43
Osman Özgür Yalın and Aynur Özge
11 A Child with Chronic Tension-Type Headache . . . . . . . . . . . . . . . . . . . . 49
Osman Özgür Yalın and Aynur Özge

vii
viii Contents

12 Cases of Cluster Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Prab Prabhakar, Lynn Macleod, and Ishaq Abu-Arafeh
13 A Child with “Paroxysmal Hemicrania” . . . . . . . . . . . . . . . . . . . . . . . . . 65
Ishaq Abu-Arafeh
14 A Child with Hemicrania Continua . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Ishaq Abu-Arafeh
15 A Child with Stabbing Headaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Rachel Howells
16 A Child with Mixed Types of Headache: Tension-Type
Headache and Migraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Osman Özgür Yalın and Aynur Özge
17 An Adolescent with Chronic Daily Headache . . . . . . . . . . . . . . . . . . . . . 85
Shashi S. Seshia and Richard J. Huntsman
18 A Child with Headache Attributed to Intracranial Neoplasm . . . . . . . . 95
Füsun Ferda Erdoğan
19 A Child with Idiopathic Intracranial Hypertension . . . . . . . . . . . . . . . 103
Pınar Tektürk, Zuhal Yapıcı, and Betül Baykan
20 A Child with Spontaneous Intracranial Hypotension . . . . . . . . . . . . . . 109
Andrew D. Hershey
21 A Child with Migraine and Chiari Malformation Type 1 . . . . . . . . . . . 113
Stewart Macleod
22 A Child with Sinusitis and Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Tal Eidlitz-Markus
23 A Child with Headache and Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Kenneth J. Mack
24 Benign Paroxysmal Vertigo of Childhood. . . . . . . . . . . . . . . . . . . . . . . . 129
Gülden Akdal
25 A Child with Cyclical Vomiting Syndrome . . . . . . . . . . . . . . . . . . . . . . . 135
Ishaq Abu-Arafeh
26 A Child with Benign Paroxysmal Torticollis . . . . . . . . . . . . . . . . . . . . . 141
Alexey Sergeev
27 A Child with Abdominal Migraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Aynur Özge
28 A Child with Headache and Chronic Fatigue Syndrome . . . . . . . . . . . 153
Jacques Bruijn
Contents ix

29 A Child with Medication Overuse Headache . . . . . . . . . . . . . . . . . . . . . 159

Osman Özgür Yalın and Aynur Özge
30 A Child with Thunderclap Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Derya Uludüz
31 A Child with Trigeminal Neuralgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Jean-Christophe Cuvellier
32 A Child with Headache and Depression . . . . . . . . . . . . . . . . . . . . . . . . . 179
Veli Yıldırım, M. Özlem Kütük, and Aynur Özge
33 A Child with Headache and Anxiety Disorder
Including School Refusal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Federica Galli, Elena Vegni, and Aglaia Vignoli
34 A Child with Headache and Attention Deficit
and Hyperactivity Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Noemi Faedda, Maria Romani, and Vincenzo Guidetti
35 A Child with Headache and Substance Abuse . . . . . . . . . . . . . . . . . . . . 201
Musa Öztürk and Refhan Balkan Öztürk
36 A Child with Chronic Posttraumatic Headache. . . . . . . . . . . . . . . . . . . 209
Ishaq Abu-Arafeh

Headache Diary of Children and Adolescents . . . . . . . . . . . . . . . . . . . . . . . . 215

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Contributors

Ishaq Abu-Arafeh, MBBS, MD, MRCP, FRCPCH Paediatric Neurosciences

Unit, Royal Hospital for Children, Glasgow, UK
Department of Paediatrics, Forth Valley Royal Hospital, Larbert, UK
Gülden Akdal Department of Neurology, Dokuz Eylül University Faculty of
Medicine, Izmir, Turkey
Semih Ayta, MD, MSc Department of Child Neurology, Haseki Training and
Research Hospital, Istanbul, Turkey
U. Balottin, MD Child Neuropsychiatry Unit, C. Mondino National Neurological
Institute, University of Pavia, Pavia, Lombardy, Italy
B. Bartoli, MD Child Neuropsychiatry Unit, Department of Clinical and Biological
Sciences, F. Del Ponte Hospital, University of Insubria, Varese, Lombardy, Italy
Betül Baykan, MD Department of Neurology, Istanbul University, Istanbul,
Turkey
Jacques Bruijn, MD, PhD Department of Pediatrics, Skaraborg Hospital, Skövde,
Sweden
S. Crugnola, MD Child Neuroslychiatry Unit, Department of Clinical and
Biological Sciences, F. Del Ponte Hospital, University of Insubria, Varese,
Lombardy, Italy
Jean-Christophe Cuvellier, MD Department of Child Neurology, Centre
Hospitalier Régional et Universitaire de Lille, Lille, France
Tal Eidlitz-Markus, MD Schneider Children’s Medical Center of Israel and
Sackler Faculty of Medicine, Pediatric Headache Clinic, Ambulatory Day Care
Hospitalization, Tel Aviv University, Tel Aviv, Israel
Füsun Ferda Erdoğan, MD Department of Neurology, Erciyes University
Medical Faculty, Kayseri, Turkey

xi
xii Contributors

Noemi Faedda Department of Pediatrics and Child and Adolescent Neuropsychiatry,

Sapienza University of Rome, Rome, Italy
Federica Galli, PhD Department of Health Sciences, University of Milan,
Milan, Italy
Vincenzo Guidetti Department of Pediatrics and Child and Adolescent
Neuropsychiatry, Sapienza University of Rome, Rome, Italy
Andrew D. Hershey, MD, PhD, FAHS Department of Neurology and Pediatrics,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of
Medicine, Cincinnati, OH, USA
Rachel Howells, MA, MB, BChir (Cantab) Department of Child Health, Royal
Devon and Exeter Hospitals NHS Foundation Trust, Exeter, Devon, UK
Richard J. Huntsman, MD, FRCP(C), CSCN(EEG) Division of Pediatric
Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon,
SK, Canada
M. Özlem Kütük Department of Child and Adolescent Psychiatry, Başkent
University, Adana Dr. Turgut Noyan Medical and Research Center, Adana, Turkey
Kenneth J. Mack, MD, PhD Department of Neurology, Mayo Clinic, Rochester,
MN, USA
Stewart Macleod, MBChB, MRCP (Glasgow) Department of Paediatric
Neurology, Royal Hospital for Children, Glasgow, UK
Lynn Macleod, MbCHB, MRCPCH Department of Paediatrics, Forth Valley
Royal Hospital, Larbert, UK
Aynur Özge, MD Department of Neurology, Mersin University School of
Medicine, Mersin, Turkey
Musa Öztürk, MD Department of Neurology, Bakırkoy Mazhar Osman Mental
Health and Neurological Diseases Education and Research Hospital, Istanbul,
Turkey
Refhan Balkan Öztürk, MD Istanbul, Turkey
Prab Prabhakar, MBBS, FRCPCH, DCH Department of Neurology, Great
Ormond Street Hospital NHS Foundation Trust, London, UK
Maria Romani, PhD Department of Pediatrics and Child and Adolescent
Neuropsychiatry, Sapienza University of Rome, Rome, Italy
Alexey Sergeev, MD, PhD Department of Neurology, I.M. Sechenov First Moscow
State Medical University, Moscow, Russian Federation
Shashi S. Seshia, MD (Bombay), FRCP (Edin&Canada) Division of Pediatric
Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon,
SK, Canada
Contributors xiii

Pınar Tektürk, MD Department of Neurology, Istanbul University, Istanbul,

Turkey
Cristiano Termine, MD Child Neuropsychiatry Unit, Department of Clinical and
Biological Sciences, F. Del Ponte Hospital, University of Insubria, Varese,
Lombardy, Italy
Derya Uludüz, MD Department of Neurology, Istanbul University Cerrahpasa
School of Medicine, Istanbul, Turkey
Elena Vegni Clinical Psychologist, S.Paolo Hospital, University of Milan,
Milan, Italy
Aglaia Vignoli, MD Department of Health Sciences, S.Paolo Hospital-Child and
Adolescent Neurology and Psychiatry, University of Milan, Milan, Italy
Çiçek Wöber-Bingöl, MD Department of Child and Adolescent Psychiatry,
Headache Outpatient Clinic for Children and Adolescents, Medical University of
Vienna, Vienna, Austria
Osman Özgür Yalın, MD Department of Neurology, Istanbul Education and
Research Hospital, Istanbul, Turkey
Zuhal Yapıcı, MD Department of Neurology and Child Neurology, Istanbul
Faculty of Medicine, Istanbul University, Istanbul, Turkey
Veli Yıldırım Department of Child and Adolescent Psychiatry, Mersin University
Medical School, Mersin, Turkey
Introduction

Headache is a worldwide problem and children from all ethnic and socioeconomic
groups are affected. In a systematic review of population-based studies, around
60 % of children and adolescents had headache over a period of 3–12 months with
more girls affected than boys over the age of 12 years [1].
Episodic tension-type headache (ETTH) is the most common headache disorder
with a prevalence of 12–25 % followed by migraine at around 8 % [1–4]. Chronic
tension-type headache (CTTH) affects around 1 % of children (mainly adolescents)
[4–6]. Other primary headaches are rare and reliable data are hard to find. Chronic
daily headache, commonly due to CTTH, is a common cause of referral to specialist
clinics and is often disproportionately represented [7].
Primary headaches have complex genetic basis and follow the biopsychosocial
model in clinical presentation, trigger factors, co-morbidity and response to treat-
ment. The trigeminocervical complex (TCC) in the brainstem, with its extensive
network of neuronal connections to the cerebral cortex, the thalamus, the vascular
system and the dura matter, plays an important role in the pathogenesis of migraine
attacks and possibly other headache disorders. Physiological, environmental or
emotional factors may trigger a micro-neuroinflammation in genetically predis-
posed individuals, causing an increase in vascular permeability, plasma extravasa-
tion and release of neurotransmitters leading to the secondary neurological, sensory
and pain phenomena.

Classification of Headache Disorders

The most recent International Classification of Headache Disorders (ICHD-3 beta)

provide a comprehensive, reliable and most utilised tool for the assessment of head-
ache disorders (Table 1) [8]. Although ICHD-3 beta is mainly aimed at headache in
adults, the system is largely applicable and can be reproducible in paediatric prac-
tice with targeted modifications.

xv
xvi Introduction

Table 1 Classification of 1. Migraine without aura

migraine—ICHD-3 beta [8]
2. Migraine with aura
Migraine with typical aura
Migraine with brainstem aura
Hemiplegic migraine
Retinal migraine
3. Chronic migraine
4. Complications of migraine
Status migrainosus
Persistent aura without infarction
Migrainous infarction
Migraine aura-triggered seizure
5. Probable migraine
Probable migraine without aura
Probable migraine with aura
6. Episodic syndromes that may be associated with migraine
Cyclical vomiting syndrome
Abdominal migraine
Benign paroxysmal vertigo
Benign paroxysmal torticollis

The headache disorders are divided into two main categories, primary and sec-
ondary headaches. Primary headaches are further subdivided into (1) migraine, (2)
tension-type headache, (3) trigeminal autonomic cephalalgias and (4) other rare
primary headaches. Secondary headaches in children are uncommon, but early
diagnosis of serious neurological disorders such as brain tumours and idiopathic
intracranial hypertension should be made as early as possible in the course of assess-
ment of a child with headache.
Migraine without aura and migraine with aura are the most common types of
migraine in children. Other forms of migraine in children are shown in the new clas-
sification of migraine (Table 1), which also introduces chronic migraine as an
important subtype of migraine and expands on the childhood abdominal migraine,
cyclical vomiting, paroxysmal torticollis and paroxysmal vertigo.
Tension-type headache is classified according to the frequency of attacks into
ETTH, which can be infrequent or frequent and CTTH (Table 2) [8].

Natural Course of Migraine in Children

The natural course of migraine in children is that of remissions (good spells) and
relapses (bad spells). It is common for children to describe well-defined periods of
high attack frequency separated by periods of relative remission. This clinical pat-
tern is often clear and easily recognised by patients with long-standing migraine
and their parents. In many children, it is not possible to identify a trigger for a bad