headache in children
Introduction
Introduction Headache refers to a symptom caused by physical and biological factors in the pain receptors of the head, which is very common in clinical practice. It is estimated that one in every 10 children or one in every four adolescents suffers from headaches, which seriously affects children's academic work and parents' work. It has caused harm to children's health and psychological development. However, there is currently insufficient understanding of it and no formal treatment. In particular, the current transitional examination has increased the economic burden of patients, the study is tense, the competition for further education is fierce, and the incidence rate is also increasing. However, the prevalence rate for migraine is 1.5-2% in Europe and the United States and 0.73% in China. The incidence rate is: 10-15% in Europe and the United States and 0.06% in China. According to the latest statistics, the total prevalence rate for one year is 11%. 6% for men and 15%-18% for women. The lifetime prevalence rate is at least 18%. 18% of children aged 13 to 15 have tension headaches and 7% have migraine headaches. Therefore, headache problems in children are already a public health problem.
Cause
Cause
There are many reasons for headaches in children. The room is stuffy, troublesome, worried, fever, illness, etc., which may cause headaches. About 20% of children will have repeated headaches, but they can't find the reason. But there are also many headaches caused by serious diseases. The common causes of headaches are as follows:
1, fever, the use of certain drugs, metabolic abnormalities, etc., can cause cerebral vascular contraction, expansion, which causes headaches.
2, migraine.
3, tension headache: often caused by mental stress, depression, tension between family members, learning difficulties and other long-term mental stimulation, more common in school-age children or adolescents.
4, brain tumors.
5, meningitis: meningitis is stimulated, it will produce headaches.
6, problems in other organs of the head, such as sinusitis, glaucoma, eye fatigue, myopia, otitis media, toothache, may also cause headaches.
7, systemic diseases: In addition to head disease, systemic diseases such as high blood pressure, kidney disease, hypoglycemia, etc. can also cause headaches.
8. Emotional reactions, including stress, depression, anxiety, stress, etc., are also common causes of headache.
Examine
an examination
The cause of headache is complicated. In the history of headache patients, the onset of headache, frequency of attack, time of onset, duration, location of headache, nature, degree of pain, presence or absence of prodromal symptoms, and clear predisposing factors should be asked. , factors that increase headaches and alleviate headaches. At the same time, in order to better identify the cause and nature of headache, we should also fully understand the age and gender, sleep and occupational status, past medical history and accompanying diseases, history of trauma, history of medication, history of poisoning and family history. . A comprehensive and detailed physical examination, especially the examination of the nervous system and the skull and facial features, helps to find the lesions of the headache. Appropriate use of neuroimaging or lumbar cerebrospinal fluid and other auxiliary examinations can provide a basis for diagnosis and differential diagnosis of intracranial organic lesions.
Diagnosis
Differential diagnosis
Differential diagnosis of headache in children:
1. Tension headache: also known as muscle contraction headache. Its clinical features are: the headache is more diffuse, and it can be placed on the forehead, eyes, top, pillow and neck. The nature of the headache is often dull, the head is oppressive, and the feeling of tightness is often said to be wearing a hat. Headaches are often persistent and can be light and heavy. There are many scalp and neck tenderness points. Massage the head and neck can relieve headaches, and there are many foreheads and neck muscles. How many are accompanied by nausea and vomiting.
2. Cluster headache: also known as histamine headache, Horton syndrome. It manifests itself as a series of intensive, transient, severe unilateral pains. Unlike migraine, the headache area is limited and fixed on one side of the ankle, behind the ball, and frontal. The onset time is often at night and the patient is awakened. The onset time is fixed, the onset is sudden without aura, and the beginning can be a burning sensation on one side of the nose or a feeling of pressure after the ball, followed by pain in a specific part, often painful, and facial flushing, conjunctival congestion, tearing, flow, stuffy nose. A large number of patients have Horner's sign, and there may be photophobia, without nausea and vomiting. The cause can be caused by alcohol during drinking, excitement, or taking vasodilators. The age of onset is often later than migraine, with an average age of 25 years, and the ratio of male to female is about 4:1. A rare family history.
3. Painful ophthalmoplegia: also known as Tolosa-Hunt syndrome. It is an inflammatory disease characterized by headache and ophthalmoplegia, involving idiopathic eyelids and cavernous sinus. The cause may be non-specific inflammation of the intracranial internal carotid artery, and may also involve the cavernous sinus. Often manifested as intractable pain and tingling after the ball and periorbital, double vision after several days or weeks, and may have neurological involvement in III, IV, VI, recurring after several months. Angiography was performed to rule out internal carotid aneurysms. Corticosteroid treatment is effective.
4. Headache caused by intracranial space occupation: early in the occupation, headache can be heavy for intermittent or morning, but with the development of the disease. More persistent headache, progressive exacerbation, symptoms and signs of intracranial hypertension, such as headache, nausea, vomiting, optic disc edema, and focal symptoms and signs, such as mental changes, hemiplegia, aphasia, partial sensation Obstacle, convulsions, hemianopia, ataxia, nystagmus, etc., typical identification is not difficult. However, it should be noted that there are also migraine manifestations of more than a decade, and finally diagnosed as a giant hemangioma.
5. Vascular headache: such as hypertension or hypotension, unruptured intracranial aneurysm or arteriovenous malformation, chronic subdural hematoma, etc. may have migraine-like headache, some cases have localized neurological signs, seizures or recognition Known dysfunction, brain CT, MRI and DSA can show lesions.
6. Migraine infarction: In rare cases, migraine can be secondary to ischemic stroke, and the two features of progressive migraine and spontaneous regression can be distinguished from stroke.
