Causes of headaches in children

Headache in children is one of the most frequent complaints with which people turn to a doctor. More than 80% of the population of the developed countries of Europe and America suffers from acute or chronic headaches.

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Causes of headaches in children

• Craniocerebral trauma (accompanied by neurologic symptoms or without it), post-comon syndrome, epi- and subdural hematomas. Criteria for the relationship of a headache to a trauma: the patient's story about the nature of the trauma and the neurological disorders that have arisen in this process; the presence in the anamnesis of cases of loss of consciousness of different duration; post-traumatic amnesia, lasting more than 10 min; the occurrence of pain no later than 10-14 days after acute craniocerebral trauma; duration of post-traumatic pain no more than 8 weeks.
• Diseases of the cardiovascular system. Myocardial infarctions, hemorrhages, transient ischemic attacks, subarachnoid hemorrhages, brain aneurysms, arteritis, venous thromboses, arterial hypertension and hypotension.
• Intracranial processes of extravascular nature. Increase in intracranial pressure (abscesses, tumors, hematomas). Occlusal hydrocephalus, low liquor pressure (post-puncture syndrome, liquorrhea).
• Infections. Meningitis, encephalitis, osteomyelitis of the skull bones, extra-cerebral infectious diseases.
• Headaches associated with metabolic diseases. Hypoxia, hypercapnia.
• Endocrine disorders.
• Diseases of the eyes, ears, paranasal sinuses, temporomandibular joint (Kosten's syndrome).
• The defeat of the cranial nerves (trigeminal neuralgia, lesion of the glossopharyngeal nerve).
• Intoxication, the intake of chemicals, drugs. Alcohol, carbon monoxide, caffeine, nitroglycerin, antidepressants, adrenomimetics, ergotamine, uncontrolled intake of analgesics.

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

Independent forms of headaches are migraine, cluster pain, tension headache.

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

Secondary headaches usually have specific signs. For example, acute severe pain throughout the head with an increase in body temperature, photophobia, rigidity of the occipital muscles indicates a meningitis. Voluminous formations, as a rule, cause subacute progressive pain, arising at night or soon after awakening, variations in the intensity of pain depending on the patient's position (lying or standing), nausea or vomiting are possible. Later, there are signs such as convulsions, impaired consciousness.

Headaches of intense type are usually chronic or prolonged, constricting, tightening. They are typically localized in the frontal or parietal areas.

Pain with subarachnoid hemorrhage arises sharply and. As a rule, intense, can last from a few seconds to several minutes. Localize more often in front of the head. The regression of pain is slow, hardly reacts to analgesics. If suspected of subarachnoidal bleeding, CT or MRI, angiography is indicated. In non-contrast studies, blood is defined as the formation of increased density, usually in basal cisterns. For diagnostic purposes, spinal puncture is also performed.

Hemorrhages in the brain. The annual frequency of cerebral circulation disorders (with the exclusion of injuries, including birth defects and intracranial infection) is 2-3 per 100 000 children under 14 and 8.1 per 100 000 adolescents 15-18 years. The most common cause of cerebral circulation disorders (IMC) in children is arteriovenous malformation. In adolescents, vasculitis, diffuse connective tissue diseases, uncorrectable arterial hypertension, lymphomas, leukemias, histiocytosis, infections with cerebrovascular thrombosis, drug addiction can be the causes of cerebral vascular disorders.

Migraines are manifested periodically by attacks of intense headache of a pulsating nature, usually one-sided. 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 comes drowsiness and lethargy.

A feature of migraine in children and adolescents is the prevalence of options without an aura, that is, the prodromal phase is not always revealed. It can manifest itself in the form of euphoria, depression. Migraine in children disorderly (dysfrenic), with disorientation, aggressiveness, distortion of speech. After an attack, the children calm down and fall asleep. With migraine, you need to record the EEG. This is the "golden rule" of diagnosis in such cases. The EEG is recorded twice: during the seizure and between attacks.

Principles of treatment of migraine attack suggest the creation of rest, limiting light and sound stimuli, the use of 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 stagnation in the nipples of the optic nerves. The severity of these symptoms depends on the extent and duration of intracranial hypertension. However, their absence does not mean against increasing the pressure. Pain may occur in the morning and decrease or fade away in the evening (with an upright position, relief comes). The first sign of beginning stagnation on the fundus is the absence of a vigorous pulse. If there is a suspicion of increased intracranial pressure, CT should be performed immediately, the lumbar puncture is contraindicated.

Benign intracranial hypertension - pseudotumor cerebri. This condition is characterized by an increase in intracranial pressure without signs of intracranial volumetric process, obstruction of the ventricular or subarachnoid system, infection or hypertensive encephalopathy. In children, intracranial hypertension can follow the thrombosis of the cerebral veins, meningitis and encephalitis, as well as treatment with glucocorticosteroids, excessive intake of vitamin A or tetracycline. Clinically, the condition manifests itself as headaches (usually mild), edema of the papilla of the optic nerve. The area of the blind spot is increasing. The only serious complication of benign intracranial hypertension syndrome - partial or complete loss of vision per eye - occurs in 5% of patients. With pseudotumor cerebri, the EEG record usually does not reveal significant changes. A CT or MRI image is normal or represents a reduced ventricular system. After an MRI or CT scan can verify normal anatomical ratios in the posterior cranial fossa, a spinal puncture is possible. A significantly increased intracranial pressure is detected, but the liquid itself is not changed. Puncture is also a curative measure. Sometimes you have to do several punctures a day to get normal pressure. However, in 10-20% of patients the disease recurs.

Pain of a strained type is the most common in this group (up to 54% of all cases of headaches). Like any subjective symptom, pain varies in strength and time, amplified by physical or mental stress. They usually occur in people whose profession is associated with a prolonged concentration of attention, emotional stress, a long uncomfortable position of the head, neck. The situation is aggravated by insufficient motor activity (both at work and during off-hours), depressed mood, fears and lack of sleep.

Clinically identify monotonous, obtuse, squeezing, constricting, aching pains, usually bilateral. Subjectively, they are perceived as diffuse, without clear localization, but sometimes patients note local pains: mainly in the fronto-parietal, frontotemporal, occipital-cervical areas, and also involving the muscles of the face, shoulders, and shoulder-shoulders on both sides, which is explained by the muscle tension cervical corset. The peculiarity of complaints is that patients describe the sensations not as pain, but as a feeling of squeezing, tightening of the head, discomfort, sensation of "helmet", "helmet", "tightening of the head". Such feelings are intensified when wearing a headdress, combing. Touching the scalp.

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

Pain associated with nerve trunks, it is common to divide into several species.

• Peripheral neuropathies (degenerative). Here the pain is usually bilateral, primarily appearing in the hands and feet, often associated with disesthesia. Often accompanied by diabetes, hypothyroidism, the intake of toxins into the body (lead, polycyclic hydrocarbons).
• Pains from compression (tunnel, carpal syndrome, history of fracture, thoracotomy followed by intercostal pain, hernia repair with later compression of the sub-genital nerve).
• Radiculopathy. The most typical manifestation is back pain with irradiation in the somato.
• Causalgia (sympathetic pain).
• Neuralgia. They can be paroxysmal and non-paroxysmal. Known primarily as a result of damage to V or X cranial nerves. Early trigger zones are formed.

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