Causes of headaches in children

Headache in children is one of the most common complaints with which people seek medical attention. More than 80% of the population of developed countries in Europe and America suffer from acute or chronic headaches.

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Causes of headaches in children

• Traumatic brain injury (with or without neurological symptoms), post-concussion syndrome, epi- and subdural hematomas. Criteria for the association of headache with trauma: patient's description of the nature of the injury and the neurological disorders that arose; history of loss of consciousness of varying duration; post-traumatic amnesia lasting more than 10 minutes; onset of pain no later than 10-14 days after acute traumatic brain injury; duration of post-traumatic pain no more than 8 weeks.
• Cardiovascular diseases. Myocardial infarctions, hemorrhages, transient ischemic attacks, subarachnoid hemorrhages, cerebral aneurysms, arteritis, venous thrombosis, arterial hypertension and hypotension.
• Intracranial processes of extravascular nature. Increased intracranial pressure (abscesses, tumors, hematomas). Occlusive hydrocephalus, low cerebrospinal fluid pressure (post-puncture syndrome, cerebrospinal fluid rhinorrhea).
• Infections. Meningitis, encephalitis, osteomyelitis of the skull bones, extracerebral infectious diseases.
• Headaches associated with metabolic diseases. Hypoxia, hypercapnia.
• Endocrine disorders.
• Diseases of the eyes, ears, paranasal sinuses, temporomandibular joint (Costen's syndrome).
• Damage to the cranial nerves (trigeminal neuralgia, damage to the glossopharyngeal nerve).
• Intoxication, intake of chemicals, medications. Alcohol, carbon monoxide, caffeine, nitroglycerin, antidepressants, adrenergic agents, ergotamines, uncontrolled intake of analgesics.

It should be remembered that the younger the patient, the more likely the cause of headaches is organic.

Migraine, cluster headache, and tension headache are considered independent forms of headache.

If there is a headache, it is necessary to clarify the frequency, location, duration and severity of pain, provoking factors and accompanying symptoms (nausea, vomiting, changes in vision, fever, muscle rigidity, etc.).

Secondary headaches usually have specific symptoms. For example, acute severe pain throughout the head with fever, photophobia, and stiff neck indicate meningitis. Space-occupying lesions usually cause subacute progressive pain that occurs at night or shortly after waking up, with variations in pain intensity depending on the patient's position (lying or standing), nausea, or vomiting. Later, symptoms such as seizures and impaired consciousness appear.

Tension headaches are usually chronic or long-lasting, squeezing, constricting. They are typically localized in the frontal or parietal areas.

Pain in subarachnoid hemorrhages occurs acutely and, as a rule, is intense, and can last from a few seconds to several minutes. It is most often localized in the front part of the head. Pain regression is slow, and it practically does not respond to analgesics. If subarachnoid hemorrhage is suspected, CT or MRI, angiography are indicated. In non-contrast studies, blood is determined as a formation of increased density, usually in the basal cisterns. A spinal puncture is also performed for diagnostic purposes.

Cerebral hemorrhage. The annual incidence of cerebrovascular accidents (excluding trauma, including birth trauma, and intracranial infection) is 2-3 per 100,000 children under 14 years of age and 8.1 per 100,000 adolescents aged 15-18 years. The most common cause of cerebrovascular accidents (CVA) in children is arteriovenous malformations. In adolescents, cerebrovascular accidents can be caused by vasculitis, diffuse connective tissue diseases, uncorrected arterial hypertension, lymphomas, leukemia, histiocytosis, infections with thrombosis of cerebral vessels, and drug addiction.

Migraine manifests itself in periodically occurring attacks of intense headache of a pulsating nature, usually one-sided. The pain is localized mainly in the orbital-temporal-frontal region and in most cases is accompanied by nausea, vomiting, poor tolerance of bright light and loud sounds (photo- and phonophobia). After the attack is over, drowsiness and lethargy occur.

A characteristic feature of migraine in children and adolescents is the prevalence of variants without aura, i.e. the prodromal phase is not always detected. It can manifest itself as euphoria, depression. Migraine in children is chaotic (dysphrenic), with disorientation, aggressiveness, and speech distortion. After the attack, children calm down and fall asleep. In case of migraine, it is necessary to record an EEG. This is the "golden rule" of diagnosis in such cases. EEG is recorded twice: during the attack and between attacks.

The principles of treating a migraine attack include creating rest, limiting light and sound stimuli, using analgesics, antiemetics and so-called specific drugs (5HT-1-serotonin receptor agonists, ergot alkaloids and its derivatives).

Increased intracranial pressure is accompanied or manifested by nausea, vomiting, bradycardia, confusion and congestion in the optic nerve papillae. The severity of the listed symptoms depends on the degree and duration of intracranial hypertension. However, their absence in no way indicates against increased pressure. Pain may occur in the morning and decrease or subside by evening (relief occurs with an upright position). The first sign of the onset of congestion in the fundus is the absence of a venous pulse. If increased intracranial pressure is suspected, CT should be performed immediately; lumbar puncture is contraindicated.

Benign intracranial hypertension - pseudotumor cerebri. This condition is characterized by increased intracranial pressure without signs of an intracranial space-occupying process, obstruction of the ventricular or subarachnoid systems, infection, or hypertensive encephalopathy. In children, intracranial hypertension may follow cerebral vein thrombosis, meningitis, and encephalitis, as well as treatment with glucocorticosteroids, excessive intake of vitamin A, or tetracycline. Clinically, the condition is manifested by headaches (usually moderate), edema of the optic nerve papilla. The area of the blind spot increases. The only serious complication of benign intracranial hypertension syndrome - partial or complete loss of vision in one eye - occurs in 5% of patients. In pseudotumor cerebri, EEG recording usually does not reveal significant changes. CT or MRI images are normal or show a reduced ventricular system. After MRI or CT allows us to be sure of normal anatomical relationships in the posterior cranial fossa, a spinal puncture is possible. Significantly increased intracranial pressure is detected, but the fluid itself is unchanged. Puncture is also a therapeutic measure. Sometimes it is necessary to do several punctures a day to achieve normal pressure. However, in 10-20% of patients the disease recurs.

Tension-type pains are the most common in this group (up to 54% of all headaches). Like any subjective symptom, pains vary in strength and duration, and are aggravated by physical or mental stress. They usually occur in people whose professions involve prolonged concentration, emotional stress, and prolonged uncomfortable positions of the head and neck. The situation is aggravated by insufficient physical activity (both at work and outside of work), depressed mood, fears, and lack of sleep.

Clinically, monotonous, dull, squeezing, tightening, aching pains are detected, usually bilateral. Subjectively, they are perceived as diffuse, without clear localization, but sometimes patients note local pains: mainly in the frontal-parietal, frontal-temporal, occipital-cervical regions, as well as with the involvement of the muscles of the face, shoulders, supraclavicular on both sides, which is explained by the tension of the muscles of the cervical corset. The peculiarity of complaints is that patients describe sensations not as pain, but as a feeling of squeezing, squeezing of the head, discomfort, a feeling of a "helmet", "hard hat", "tightness of the head". Such sensations intensify when wearing a hat, combing, touching the scalp.

Post-traumatic pain develops after a concussion or brain injury or as a result of cervical spine injuries. They can be extremely intense and persistent. Moreover, there is no correlation between the severity of the injury, the presence of post-traumatic pain syndrome and its severity. The syndrome is often combined with fatigue, dizziness, drowsiness, impaired perseverance and attention.

Pain associated with nerve trunks is usually divided into several types.

• Peripheral neuropathies (degenerative). Here, pain sensations are usually bilateral, primarily appearing in the hands and feet, often associated with dysesthesia. Often accompany diabetes mellitus, hypothyroidism, and the entry of toxins into the body (lead, polycyclic hydrocarbons).
• Pain from compression (tunnel, carpal tunnel syndrome; history of fracture, thoracotomy with subsequent intercostal pain; herniotomy with later development of compression of the iliogenital nerve).
• Radiculopathy. The most typical manifestation is back pain radiating to the somata.
• Causalgia (sympathetic pain).
• Neuralgia. May be paroxysmal and non-paroxysmal. Known primarily as a result of damage to the V or X cranial nerves. Trigger zones are formed early.

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