[Childhood headache. A diagnostic approach]. / La cefalea en la infancia. Una aproximación diagnóstica.

Headaches are common during childhood and become more frequent in adolescence. The rational, cost-effective evaluation of children with headache begins with a careful history. The first step is to identify the temporal pattern of the headache -acute, acute-recurrent, chronic-progressive, chronic-nonprogressive, or mixed. The next step is a physical and neurologic examination. Neuroimaging is not routinely warranted in the evaluation of childhood headache and should be reserved for use in children with acute or chronic-progressive patters of abnormalities in neurologic examination. Pediatric migraine differs from adult migraine. Recent studies indicate the need to revise diagnostic criteria for pediatric migraine, which would allow its real prevalence in this age group to be determined. The sensitivity and specificity of the International Headache Society (IHS) criteria for childhood migraine would be increased if the minimum duration of migraine were reduced and if a diagnosis of migraine were allowed when severe headache is associated with nausea, even though the criteria of location, quality, and aggravation by physical activity are not fulfilled. There are no differences in the fulfillment of the IHS criteria for migraine and tension-type headache between children and adolescents. Independent of age, the intensity of headache and the presence or absence of nausea are the most important features for differentiating the two major types of idiopathic headache.Migraines, migraine variants, tension headache and other types of headache often present for the first time during childhood and require close follow-up by the pediatrician. Investigation into this disorder is still developing.

La cefalea en la infancia. Una aproximación diagnóstica / Childhood headache. a diagnostic approach

La cefalea es un padecimiento común en la infancia, y su frecuencia se incrementa en la adolescencia. En la valoración de la cefalea, la historia clínica ha demostrado ser el instrumento más racional y efectivo en la valoración de esta enfermedad. El primer paso en su evaluación es identificar el patrón que adopta esta cefalea (agudo, agudo-recurrente, crónico-progresivo, crónico-no progresivo o mixto). El siguiente paso es realizar una exploración física y neurológica completa. No es necesario realizar estudios de neuroimagen de forma sistemática para valorar al niño con cefalea, sólo deben utilizarse ante la presencia de signos de alarma, que por lo habitual se relacionan con un patrón de cefalea agudo o crónico-progresivo o con alteraciones en la exploración neurológica. La sintomatología de la migraña en edades pediátricas difiere de la que se presenta en el adulto. Recientes estudios demuestran la necesidad de revisar los criterios diagnósticos de la migraña en la infancia, lo que permitirá conocer su prevalencia real en estas edades. La sensibilidad y especificidad de los criterios de la International Headache Society (IHS) para migraña en la infancia aumentarían si se ajustase el criterio de duración de unos episodios de cefalea de gran intensidad asociados a náuseas, sin considerar la localización, la calidad o la relación con la actividad física del dolor. No existen diferencias semiológicas en las características de la cefalea tipo migraña o tensional entre niños y adolescentes, estos procesos se diferencian fundamentalmente en la intensidad y la presencia o ausencias de clínica vegetativa. Tanto la cefalea tipo migraña (incluyendo sus variantes), la cefalea tensional y otros tipos de cefalea se inician durante la infancia, requiriendo un estrecho seguimiento por parte del pediatra, en una enfermedad que todavía es un campo de investigación en desarrollo (AU)

Side-effects of sodium valproate, mainly related to its hepatic and pancreatic toxicity.

A study was made of 134 patients (67 males and 67 females) treated with sodium valproate, with ages from 1.5 to 70 years (50 on monotherapy and 84 on multitherapy), to detect side-effects of this treatment. To meet this goal, a clinical questionnaire was used with special emphasis on biological parameters to detect hepatic and pancreatic toxicity. 71.6% developed side-effects, without differences either between groups of sex or age, or patients on monotherapy and multitherapy, or the duration of the treatment, longer or shorter than six months. The side-effects were mild and transient, and without relationship with doses or plasma levels of the drug. The most noticeable side-effects in the study were the increase in amylase values, mainly in urine (23.9%), eosinophilia (30% in the monotherapy group), increase in gamma-glutamyltranspeptidase (20.2% in the polytherapy group) and weight gain in 25% of adult women on polytherapy. Only a 4.7% developed mild and transient elevation of transaminases, that did not differ from the control population. The relevance of using a clinical questionnaire and biological parameters to evaluate the side-effects of a drug is emphasized.