Headache in childhood: A critical review of 265 patients

Objective. Headache frequently affects adults but is also present in children and adolescents. We have reviewed a case series of Sicilian children and adolescents affected by headache, with the main aim of observing type, age at onset, positive family history, and comorbidity. Methods. A sample of 265 patients was selected on the basis of the International Headache Society criteria and followed up for at least 3 years; of these 136 (51%) were males and 129 females, with a median age of 7.6 (SD 2.327) and a range of 3-17 years. All patients underwent standard clinical and laboratory examination, including EEG, fundoscopy and psychiatric tests, with clinical follow-up examinations. Results. Common migraine affected 113 patients (42.7%) with a median onset of symptoms at age 7.6 years; classic migraine was present in 12 patients (4.5%) with a median age at onset of 8.5 years; complicated migraine, 12 patients (4.5%), median age at onset 6.5 years; migraine variants, 6 patients (2.3%), median age at onset 8.6 years; tension headache, 82 patients (31%), median age at onset 7.3 years. A relationship between headache and epilepsy was observed in 16 patients (6%), with a median age at onset of 7 years. Secondary headache was observed in 24 patients (9%) with a median age at onset of 8.7 years. Conclusion. Headache is a frequent disorder also in childhood and adolescence. In many cases the episodes are mild and isolated and their occurrence tends to disappear within 1 year in 26.4% of patients. The EEG is non diagnostic, except for the comorbid seizure patients, where headache/epilepsy comorbidity is a not infrequent finding.