Short-term outcomes of tension type and migraine headache in children.

OBJECTIVE: To study the short-term outcome and the factors associated with the outcome in childhood tension type and migraine headache patients. MATERIAL AND METHOD: Children aged 16 years or less with first diagnosed of either migraine or tension-type headache were reassured the cause of headache and treated by avoiding triggering factors, taking intermittent analgesics or a daily preventive medication such as propanolol 10 mg two times a day or amitriptyline 10 mg at night for patients who were suffered from the frequent headache attacks whether had to stop activity or go to sleep. They were followed up at 2 weeks and 2 months to confirm the diagnosis and the response to the treatment. The short-term outcomes and the possible factors associated with the outcomes were analysed. RESULTS: Pre-treatment 81% of migraine patients and 43.5% of tension-type patients were significant frequently suffered from headache attacks. Post-treatment revealed that it reduced to 4% in migraine patients and 16% tension-type patients. Gender; age at onset, severity before treatment, precipitating factors; hot weather sleep deprivation, learning stress, familial stress, night awakening, familial history of headache were not statistically significant in short-term outcomes. CONCLUSION: Treatment childhood tension-type and migraine headache by reassurance, avoid the probably precipitating factors, intermittent analgesics and usage of amitriptyline or propanolol had good efficacy in reducing the severity of attack. The authors cannot identify the associated factor with the outcome of treatment.

375 childhood primary headache: clinical features, the agreement between clinical diagnosis and diagnoses using the international classification of headache disorders in Thai children.

OBJECTIVE: To study the clinical features of patients with headache and agreement between clinical diagnoses and ICHD II criteria diagnosis in primary headaches in Thai children. MATERIAL AND METHOD: Patients with headache who, over a 4-year period, consulted the neurological clinic, were interviewed by questionnaire, examined, diagnosed, treated, and followed up by pediatric neurologists. The result from the questionnaire was used to define the type of headache according to the ICHD II criteria. The clinical features were analyzed and clinical diagnosis was compared with diagnoses using the International Classification of Headache disorders. RESULTS: Three hundred and seventy-five primary headache patients were defined by ICHD II criteria. One hundred twenty eight (35.2%) were migraine, 47 (12.5%) were tension-type, 123 (33.3%) were probable migraine, 31 (8.3%) were probable tension-type, and 40 (10.7%) cannot be classified because the symptoms were not compatible with diagnosed criteria. Using clinical diagnosis as the standard, the sensitivity of the ICHD-based definition of migraine without aura and probable migraine was 89.96% whereas the specific was 65.09%. On the other hand, the sensitivity of the International Classification of Headache disorders-based definition of infrequent episodic tension-type and probable infrequent episodic tension-type was 56.34% whereas the specific was 87.50%. CONCLUSION: The present study shows the increase of sensitivity but decrease of the specificity of ICHD II criteria in diagnosed pediatric migraine headache. However, the duration of attack and quality of headache are still the limitation of diagnosis for pediatric headache. Therefore, the diagnosis criteria in pediatric headache should be developed distinctly from adults.