Cefaleas agudas recurrentes: características clínicas y epidemiológicas

Resumen

Objective To analyze the epidemiological and clinical characteristics of migraine and tension-type headache in the pediatric age group with the aim of facilitating their differential diagnosis in clinical practice. Patients and methods Information on epidemiological and clinical characteristics, physical examination and complementary examinations, if performed, was collected from the medical records of 225 children with acute recurrent headache. The criteria defined by the International Headache Society (IHS) were used in the diagnosis. Results A total of 98.2 % of the patients had primary headache: migraine (48.9 %), tension-type headache (48.4 %) and mixed (0.9 %). Thirty percent of those with migraine had migraine with aura. The mean age at onset was 8.6 ± 2.9 years in migraine and 9.7 ± 2.5 years in tension-type headache (p < 0.05), with no differences between sexes. Children with tension-type headache showed a greater prevalence (p < 0.05) of female sex, urban origin and excellent academic performance. Children with migraine had a greater prevalence (p < 0.05) of positive family history. Migraine headaches were unilateral (44.1 %) or bilateral (55.9 %), pulsating (77.1 %), aggravated by physical activity (68.8 %), caused lost days at school (65.3%) and were usually accompanied by vomiting (71 %) and photophobia/ sonophobia (67 %). Tension-type headaches were bilateral (81.8 %) and oppressive (85.3 %), were less frequently aggravated by physical activity (11.8 %) or interrupted activities (11.8 %) and were occasionally accompanied by vomiting (7.3 %) and photophobia/sonophobia (21.8 %). Electroencephalogram and brain computed tomography scan were performed in 21 % and 39.1 % of the patients, respectively, without changing their diagnosis. Conclusions Migraine and tension-type headaches are a common cause of recurrent headache in the pediatric age group. Onset usually occurs in school-aged children. The IHS criteria for the differential diagnosis of headache in children are useful, although follow-up is the gold standard to validate diagnostic criteria