Screen time and pediatric headache: A scoping review of the literature.

OBJECTIVE: The aim of this study was to summarize the evidence regarding screen use as a contributing factor in pediatric headache and migraine. BACKGROUND: Screen exposure is often reported as a headache trigger, though there is no current consensus in terms of how screen type, duration, or frequency influences pediatric headache and the associated burden of disease. METHODS: A systematic search in PubMed, Scopus, Cochrane Library, ProQuest Health and Medical Database, and Google Scholar was performed through November 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All English-language articles of pediatric patients aged ≤18 years evaluating screen use in relation to headache were included. RESULTS: A total of 48 studies were included. Nearly all studies were cross-sectional and represented international samples. The strongest association between screen use and headache found was for duration of use, and computer use emerged as the most common device type related to headache. While there were mixed findings related to screen use and specific headache diagnosis, migraine appeared to confer a higher risk. Across studies, there were insufficient data to assess the impact of screen use on headache frequency or headache-related disability. Several studies demonstrated changes in screen use and headache patterns related to the COVID-19 pandemic and computer vision syndrome was commonly reported. CONCLUSIONS: While there is preliminary evidence supporting possible associations between screen use and pediatric headache, there are several limitations in the present review including a lack of prospective and randomized controlled trials to better demonstrate causal relationships as well as methodological limitations with significant variability in how both headache and screen use are defined and measured. Future studies including real-time screen use and device monitoring are needed to better understand the influence of screen use behaviors on pediatric headache and to help further define best-use guidelines around these technologies.

Bilateral Retinal and Lateral Geniculate Nucleus Infarction in an Adolescent With Influenza.

We describe a 13-year-old female with influenza complicated by bilateral vision loss due to retinal and lateral geniculate nucleus (LGN) infarctions. She continues to have near-total vision loss in her left eye 3.5 years later. This is the second reported case of bilateral retinal and LGN infarctions in the setting of influenza. The mechanism of infarction remains to be determined, but it is important to recognize this entity and counsel patients appropriately as visual recovery may be poor.

Pediatric screen exposure and school related headache disability.

BACKGROUND AND OBJECTIVES: Prolonged screen exposure is often cited as a trigger for pediatric headache. We present initial findings evaluating the association between adolescent screen use type, duration, and school disability. METHODS: New patients aged 12-17 years presenting to a headache clinic were screened and surveyed regarding headache characteristics, behavioral habits, school attendance, and screen utilization. RESULTS: 99 adolescents (29 M, 70 F) with average age 14.8 years and average headache frequency of 17 days per month completed the survey. Patients missed an average of five full days and three partial days of school due to headaches over the 90 days prior to survey completion.No statistically significant correlation was found between type or duration of screen exposure and monthly headache frequency, school attendance, or school functioning. A small positive association was seen between increasing duration of computer use, total hours screen use, and school absenteeism. While most adolescents reported prolonged screen use (58.6%) and luminosity (64.6%) worsened headaches, no statistical difference was seen in average number of headache days per month. CONCLUSIONS: Average monthly headache frequency in an adolescent population was not significantly correlated with type or duration of screen exposure. Further studies are needed to elucidate how screen utilization impacts school related headache disability.

Gaps in Neurogenetics Education During Child Neurology Residency: Results of a National Survey.

The practice of child neurology has changed significantly in the past two decades as we have integrated genetic testing into our standard of care to achieve precise diagnoses and to guide management of many childhood neurological conditions. Despite this paradigm shift, there appears to be a gap in both clinical exposure to neurogenetic disorders and education provided to residents in ordering and interpreting genetic testing. We therefore conducted a national survey for child neurology trainees in all programs across the United States to delineate their perception of the adequacy of current training and didactics in genetic/neurogenetic disorders. The results revealed knowledge gaps related to ordering and interpreting genetic testing, managing acute metabolic emergencies, and identifying resources for referral of patients to clinical trials. Responders considered their current curriculum in neurogenetics to be insufficient and voted favorably for an educational platform using recorded lectures and interactive sessions.

Natural History of Abortive Medication Withdrawal in the Management of Pediatric Medication Overuse Headache.

OBJECTIVE: The objective of this study is to document pain scores during withdrawal of abortive medication in patients diagnosed with medication overuse headache. DESIGN: Cross-sectional study. SETTING: Children's National Hospital's Headache Program. SUBJECTS: Patients 6-18 years of age who presented to the Headache Clinic at Children's National Hospital with presumed medication overuse headache between March 2017 and March 2019 were invited to participate. METHODS: Patients were instructed to abruptly discontinue overused medications and record their headache characteristics daily in a diary for 8 weeks. RESULTS: Fourteen diaries were returned and analyzed at a 4-week follow-up visit. Ninety-three percent of the patients were females, with a median age of 14.9 years (standard deviation [SD] = 2.0). The average headache intensity upon study entry was 4.7 out of 10 (SD = 2.5), and the average headache intensity upon study completion was 3.1 (SD = 2.5). Of the patients, 57% had daily headaches upon study entry, 71% had improved pain intensity from the first diary entry to the last diary entry, and 57% had complete headache resolution at an average of 7.6 days from medication discontinuation (SD = 5.1). Ibuprofen was the most overused medication (71%). CONCLUSIONS: Our findings suggest that medication overuse headache will improve in the majority of pediatric patients who abruptly stop the offending medication(s) in an average of 8 days from withdrawal. Average pain intensity was reduced by more than one point among all patients who stopped taking abortive medications. Further larger-scale studies on medication withdrawal in pediatric patients with medication overuse headache could help us better understand whether this management strategy is effective.

Pediatric Migraine and Academics.

PURPOSE OF REVIEW: The purpose of this review is to examine the multitude of factors which may impact learning and academic performance in patients with pediatric migraine. RECENT FINDINGS: A range of associations of varying degree were noted between pediatric migraine and conditions such as ADHD, learning disabilities, sleep disorders, and psychiatric comorbidities with regard to headache pain and school functioning. Recent literature highlights the importance of sleep in relation to headache, mood disorders, and learning in youth and the emerging role of perfectionism. Children with migraine remain at risk for school related and learning difficulties which may be primarily due to pain, due to other medical and psychiatric comorbidities commonly found in this population, or a combination. The relationships are complex and further studies are needed to clearly elucidate the shared biological and environmental pathophysiologic mechanisms.

Pediatric headache: overview.

PURPOSE OF REVIEW: Headache is a common medical complaint in children and adolescents with the majority having experienced some type of headache by their teenage years. Pediatric headache presentations often differ compared to adults, and children may have difficulty describing their symptoms. Thus, a thorough understanding of the approach to the pediatric headache patient is essential to ensure appropriate diagnosis, evaluation, and management. RECENT FINDINGS: In the following article we will review the components of a comprehensive pediatric headache assessment, as well as discuss primary and secondary headache types seen in children with focus on clinical pearls and 'red flags' necessitating diagnostic testing. SUMMARY: Headaches in children may be due to primary or secondary etiologies. Common primary headache types include migraine or tension-type headache. Secondary headache causes are broad and include infections, trauma, vascular disorders, substance use/withdrawal, and psychiatric conditions. Current American Academy of Neurology (AAN) guidelines recommend against routine lab studies, lumbar puncture, electro-encephalogram (EEG), or neuroimaging in patients with no headache red flags by history and a normal neurologic examination.