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Idiopathic Headache in Children Under
Six Years of Age: A Follow-Up Study
Balottin U, Termine C, Nicoli F, et al.
Posted: August 2005
Objective: To assess the evolution of
idiopathic headache with early onset and to investigate the
influence of early somatic disorders, "life events", and psychiatric
disorders on the onset and the course of headache. We also studied
the possible prognostic role of gender, headache diagnosis at onset,
and history of headache in family members on the course of headache.
We also investigated the applicability of the ICHD-II criteria to
idiopathic headache in preschool children.
Methods: Prospective evaluation of 25 consecutive
headache patients referred before the age of 6 years. Headache
diagnosis was based on the IHS 1988 criteria, on the ICHD-II
criteria, and on "alternative" clinical criteria (e.g. duration
less than 1 hour in migraine without aura, less than 30 minutes
in tension-type headache). All patients were assessed by a
structured interview to detect early developmental disorders (e.g.
feeding difficulties or sleep disorders) and "life events" (e.g.
parents’ separation and others according to DSM-IV). All patients
underwent clinical observations and assessment of psychiatric
comorbidity by means of interviews and the Child Behavior Check
List. All the above-mentioned evaluations were performed at
recruitment and at the end of the follow-up period.
Conclusions: Our results suggest that the ICHD-II
criteria are too restrictive to allow the classification of
migraine without aura and tension-type headache in preschool
children. Nevertheless, a diagnosis based on these criteria
was possible in all the patients with headache persistence at
the end of several years’ follow-up. We found a significant
association between early somatic disorders and persistence of
headache and also between the presence of psychiatric disorders
at the end of follow-up and the persistence of headache. "Life
events", on the other hand, while not showing a statistically
significant association with the evolution of the headache, may
nevertheless influence the course of the headache in some patients.
Our results suggest that environmental and psychological factors
play an important role in idiopathic headache with onset in
preschool age, and thus that the diagnostic-therapeutic approach
must take these factors into account.