Spotlight on Headache in children: overview and treatment approaches

Primary headaches, particularly those that are recurrent or chronic, in childhood are increasingly being recognized as a significant neurologic health problem. The high incidence and prevalence of headaches in the pediatric population has a significant impact on children and their families. Migraine remains under-recognized, under-diagnosed, and ultimately under- or inappropriately treated in this population; this has potential long-term consequences with regards to disease progression.

In this article, Dr. Nina Schor of the University of Rochester Medical Center and Chair of the Department of Pediatrics at Golisano Children’s Hospital at Strong has addressed the key issues of: (1) using practical diagnostic criteria for clinical practice, (2) which acute medication should be chosen, and (3) when to use preventive therapy in childhood. This article serves as a quick reference for the diagnosis and management of primary headache disorders in children and adolescents. Effective intervention may prevent progression and lifelong consequences, including the development of comorbidities. Early diagnosis and an integrative treatment approach are essential to minimize the impact on a child’s quality of life.

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Spotlight on SUNCT syndrome

SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is one of the rarest of all primary headache syndromes. It is one of the trigeminal autonomic cephalalgias, along with cluster headache and paroxysmal hemicrania. It is marked by frequent, short-lasting attacks of 1-sided headache with associated cranial autonomic symptoms. SUNCT forms the majority subset of SUNA (short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms), in which the combination of conjunctival injection and tearing are not required for diagnosis. Reports and series have shown therapeutic benefits with medical treatments. Structural imaging studies report an association with aberrant vessel in contact with the trigeminal nerve, and functional imaging studies report hypothalamic activation. Microvascular decompression, occipital nerve stimulation, posterior hypothalamic region deep brain stimulation, and focal radiation therapy have all been reported to be effective in medically intractable cases.

In this article, Dr. Hans-Christoph Diener of the University of Essen discusses the clinical manifestations, biological basis, diagnosis, and management of SUNCT syndrome.

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Spotlight on Rhinosinus-related headache

Sinus headache is commonly diagnosed when patients have facial pain and pressure accompanying their headache. However, it is not as common as believed; the headache must accompany acute rhinosinusitis, a diagnosis that is based both on clinical and radiologic evidence. Many patients who are diagnosed with sinus headache and treated with antibiotics have a primary headache, usually migraine. In 2013, the International Headache Society revised the criteria for headache caused by rhinosinusitis. However, these criteria may not be valid for sphenoid sinusitis. In this clinical summary, Dr. Wei-Ta Chen of Taipei Veterans General Hospital explains the key points for diagnosis of rhinosinus-related headache and updates pertinent advances in this headache disorder.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Abdominal migraine

Abdominal migraine is recognized as the migraine equivalent of infancy, childhood, and adolescence and is often underdiagnosed in those with chronic, idiopathic, and recurrent abdominal pain. Abdominal migraine is recognized as a periodic paroxysmal syndrome without associated headache, which is thought to be migrainous in etiology. In this clinical summary, Dr. Shuu-Jiun Wang, Professor at National Yang-Ming University School of Medicine and Deputy Director of the Neurological Institute at Taipei Veterans General Hospital in Taipei, Taiwan, updates new findings for abdominal migraine as well as for a condition referred to as cyclic vomiting syndrome.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Epidemiology of headache

Headache is one of the most common complaints encountered in neurologic services. Information concerning sociodemographic, distribution, impact, familial, and environmental risk factors may provide clues to diagnosis and management of headache preventive strategies and disease mechanisms. Dr. Chaichana Nimnuan and Dr. Anan Srikiatkhachorn of Chulalongkorn University in Bangkok, Thailand review the epidemiology of primary headaches, including migraine, tension-type headache, chronic daily headache, and cluster headache.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Cluster headache

Cluster headache is a relatively common, very severe form of primary headache that belongs to the family of trigeminal autonomic cephalalgias. It involves dysfunction of central nervous system elements concerned with pain control and with links to circadian and circannual mechanisms. Acute cluster headache can be treated with oxygen, intranasal triptans (sumatriptan and zolmitriptan), and injected sumatriptan. Medicines or strategies useful in the preventive management of cluster headache include verapamil, lithium, methysergide, corticosteroids, topiramate, and melatonin. In this clinical summary, Dr. Goadsby summarizes the current understanding and management of cluster headache, including an update on the latest clinical trial data.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Headache attributed to head trauma

Headache is common following head injury. Most individuals recover within days, weeks, or months, but a minority of subjects may suffer from intractable posttraumatic headache despite treatment. Posttraumatic headache remains a subject of controversy over the years concerning its pathophysiology. Litigation and medicolegal problems further complicate this issue. In this clinical summary, Dr. Kai-Chen Wang of Cheng Hsin General Hospital in Taiwan summarizes current understanding of posttraumatic headache, including a brief historical review of the disease, the classification and diagnostic criteria, the epidemiology, clinical manifestations, pathophysiology, diagnostic evaluation, and management.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Headache associated with intracranial infection

Headache is usually the first and the most frequently encountered symptom in intracranial infection. It is usually generalized (but may be predominantly frontal); it may radiate down the neck and back and into the extremities, and it is severe and unremitting. Encephalitis is characterized by headache, fever, alteration of consciousness, focal neurologic deficit, and seizures (usually focal). Because the brain parenchyma has no sensory receptors, the headache of encephalitis and brain abscess may result from the meningeal inflammation that often accompanies these processes, including a nonspecific response to fever, increased intracranial pressure, or a mass-effect producing traction on pain-sensitive intracranial structures. The most common causes of brain abscesses are otorhinogenic. Physical signs of meningeal inflammation do not help clinicians rule in or rule out meningitis accurately.

In this clinical summary, Dr. Jong-Ling Fuh of Taipei Veterans General Hospital and National Yang-Ming University School of Medicine discusses the clinical presentation and diagnosis of headache associated with intracranial infection.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Headache associated with low CSF pressure

In this clinical summary, Yen-Feng Wang MD of the Taipei Veterans General Hospital reviews new concepts in spontaneous intracranial hypotension. He discusses the role of CSF volume depletion and addresses the substantial variability in the clinical aspects, imaging findings, and CSF abnormalities related to this disorder. Pre-existing dural defects, likely related to disorders of the connective tissue matrix, are sometimes seen and contribute to the often complex anatomy of these spontaneous leaks, presenting therapeutic challenges far beyond the expected management of post-lumbar puncture or even post-epidural catheterization CSF leaks. An update with special emphasis on recent advances of the imaging techniques to localize CSF leaks and treatment options is provided.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Headache associated with ischemic cerebrovascular disease

Headache often accompanies acute ischemic stroke. Observational studies indicate that 15% to 40% of patients with acute ischemic stroke report headache in close temporal relation to the event. The onset headache is more often seen in posterior circulation strokes than in strokes in other vascular territories. The pathophysiology of headache associated with acute ischemic stroke includes edema, hemorrhagic transformation, and changes in the trigeminovascular system. In this clinical summary, Dr. Hans-Christoph Diener of the University of Essen discusses headache associated with ichemic cerebrovascular disease.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.