Çocuklarda tekrarlayan başağrılarının sıklığının ve eşlik eden hastalıkların belirlenmesi
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Date
2010
Authors
Özdemir, Özlem
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Publisher
Uludağ Üniversitesi
Abstract
Baş ağrısı çocuklarda ve ergenlerde sık olarak karşılaşılan bir yakınmadır. Tekrarlayan baş ağrılarının en sık nedeni migrendir. Yaş ilerledikçe gerilim tipi baş ağrısı sıklığı da artış göstermektedir. Migren veya ciddi baş ağrısı yakınması olan çocuklarda tahmin edilenden daha fazla oranda diğer medikal problemler de eşlik etmektedir. Çocuklarda tekrarlayan baş ağrıları ve özellikle eşlik eden hastalıkların incelendiği çalışmalar oldukça sınırlıdır. Çalışmamızda tekrarlayan baş ağrısı yakınması ile başvuran hastaların baş ağrılarının özelliklerinin, tetikleyen faktörlerin, eşlik edebilen diğer hastalıkların belirlenmesi ve elde edilen verilerin literatür eşliğinde tartışılması amaçlanmıştır.Haziran 2009 ile Aralık 2009 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Çocuk Genel polikliniğine tekrarlayan baş ağrısı yakınması ile başvuran 102 hasta çalışmaya alındı. Hastalarla yüz yüze görüşme yapıldı. Bu görüşmeler sırasında hastaların demografik ve yaşam özellikleri, beslenme alışkanlıkları, baş ağrısı özellikleri, tetikleyici faktörler ve eşlik eden hastalıklar sorgulandı. Baş ağrısının tanısı için Uluslararası Baş Ağrısı Birliği'nin (ICHD-II) kriterleri kullanıldı. Hastalar yaş gruplarına göre 2-5, 6-11, 12-15 ve 16-18 yaş olmak üzere 5 gruba ayrıldı.Çalışmada 61 kız, 41 erkek hasta yer aldı. Hastaların ortalama yaşları 153,55 ± 37,25 idi. Baş ağrısı en çok 12-15 yaş grubunda gözlendi. 6-11 yaş ve 12-15 yaş grubunda kızlar ve erkeklerin sayısı benzer iken 15 yaşından itibaren kızların sayısında anlamlı olarak artış saptandı (p=0,037). En sık baş ağrısı nedeni migrendi (%52). Bunu sırasıyla gerilim tipi baş ağrısı (%32,4), sinüzit (%7,8) ve diğer nedenler (kitle, hipertansiyon gibi) (%7,8) izledi. Stres, uykusuzluk, yorgunluk ve gürültü sık ifade edilen tetikleyici faktörlerdi. Stres ve ışık migren, açlık ise gerilim tipi baş ağrısı için spesifikti. Hastaların yaşam özellikleri ve beslenme alışkanlıkları tanılara göre farklılık göstermedi. Psikiyatrik komorbiditenin ve uykuya geçişte zorluğun gerilim tipi baş ağrısına daha fazla eşlik ettiği görüldü (p=0,006, p=0,035). Ağrını süresinin kilo artışı ile birlikte anlamlı olarak arttığı saptandı (p=0,015). Kranial magnetik rezonans, bilgisayarlı tomografi, elektroensefalografi ve sinüs grafisinde baş ağrısı ile ilişkili bulguların oranı sırasıyla %11,2, %8,3, %8,8 ve %13,3 idi.Sonuç olarak, en sık baş ağrısı nedeninin migren, ardından sırasıyla gerilim tipi baş ağrısı, sinüzitin ve diğer sekonder nedenlerin olduğunu saptadık. Tetikleyici faktörlerin ve eşlik eden hastalıklarının tespitin hem önlem hem de tedavi açısından oldukça faydalı olabileceği düşünülebilir. Baş ağrısının tanısında en önemli nokta ayrıntılı anamnez ve eksiksiz fizik ve nörolojik muayenedir.
Headache is a common complaint in children and adolescents. The most frequent type of recurrent headache is migraine, while the frequency of tension type headache increases in the later years of childhood. Children who suffer from migraine or severe headache are also diagnosed with other medical conditions at a higher frequency than expected. There are limited studies which investigate headache and associated comorbidities in children. In this study, we aimed to identify the headache features, triggering factors and comorbidity and to discuss the present data with literature.One hundred and two children who admitted to the Uludag University Medical Faculty General Outpatient Clinic between June 2009 and December 2009, were enrolled in this study. The patients were asked questions face to face by interview. During these visits, demographic factors, life and alimentary features, headache features, triggering factors and comorbid medical conditions were analyzed. The criteria defined by the International Headache Society (IHS-II) were used for the classification of patients. The patients were divided into subgroups according to the age as 2-5, 6-11, 12-15 and 16-18 years.There were 61 females and 41 males in this study. The average age of patients was 53,55 ± 37,25 months. Headache was commonly observed between 12 and 15 years of age. While headache was similar for gender in 6-11 and 12-15 age group, there was an increasing incidence in girls after 15 years of age and it was significantly higher than boys (p=0,037). The most frequent cause of headache was migraine (52%). The remaining causes were tension type headache (32,4%), sinusitis (7,8%) and other reasons (7,8%) (such as occupying lesions, hypertension). Stress, sleep deprivation, fatigue and noise were the most triggering factors. While stress and light were specific for migraine, hunger was specific for tension type headache.There were no significant differences with respect to lifetime and alimentary features. The rates of psychiatric comorbidy and the difficulty in the initiating sleep were significantly higher in tension type headache group (p=0,006, p=0,035). The duration of headache significantly increased with weight (p=0,015). The percentage of findings relevant to headache determined in magnetic resonans images, computed tomographic scans, electroencephalograms and sinus radiographs were respectively 11,2%, 8,3%, 8,8% and 13,3%.In conclusion; we found that the most frequent cause of headache in childhood was migrain which was followed by tension type headache, sinusitis and other secondary reasons. It could be suggested that identifying the triggering factors and comorbide conditions might be effective for preventive approach and treatment. The most important point for the diagnosis of headache is taking a proper history of headache and performing a thoroughly physical and neurological examination.
Headache is a common complaint in children and adolescents. The most frequent type of recurrent headache is migraine, while the frequency of tension type headache increases in the later years of childhood. Children who suffer from migraine or severe headache are also diagnosed with other medical conditions at a higher frequency than expected. There are limited studies which investigate headache and associated comorbidities in children. In this study, we aimed to identify the headache features, triggering factors and comorbidity and to discuss the present data with literature.One hundred and two children who admitted to the Uludag University Medical Faculty General Outpatient Clinic between June 2009 and December 2009, were enrolled in this study. The patients were asked questions face to face by interview. During these visits, demographic factors, life and alimentary features, headache features, triggering factors and comorbid medical conditions were analyzed. The criteria defined by the International Headache Society (IHS-II) were used for the classification of patients. The patients were divided into subgroups according to the age as 2-5, 6-11, 12-15 and 16-18 years.There were 61 females and 41 males in this study. The average age of patients was 53,55 ± 37,25 months. Headache was commonly observed between 12 and 15 years of age. While headache was similar for gender in 6-11 and 12-15 age group, there was an increasing incidence in girls after 15 years of age and it was significantly higher than boys (p=0,037). The most frequent cause of headache was migraine (52%). The remaining causes were tension type headache (32,4%), sinusitis (7,8%) and other reasons (7,8%) (such as occupying lesions, hypertension). Stress, sleep deprivation, fatigue and noise were the most triggering factors. While stress and light were specific for migraine, hunger was specific for tension type headache.There were no significant differences with respect to lifetime and alimentary features. The rates of psychiatric comorbidy and the difficulty in the initiating sleep were significantly higher in tension type headache group (p=0,006, p=0,035). The duration of headache significantly increased with weight (p=0,015). The percentage of findings relevant to headache determined in magnetic resonans images, computed tomographic scans, electroencephalograms and sinus radiographs were respectively 11,2%, 8,3%, 8,8% and 13,3%.In conclusion; we found that the most frequent cause of headache in childhood was migrain which was followed by tension type headache, sinusitis and other secondary reasons. It could be suggested that identifying the triggering factors and comorbide conditions might be effective for preventive approach and treatment. The most important point for the diagnosis of headache is taking a proper history of headache and performing a thoroughly physical and neurological examination.
Description
Keywords
Çocukluk çağı, Baş ağrısı, Etyoloji, Tetikleyici faktörler, Komorbidite, Childhood, Headache, Etiology, Triggering factors, Comorbidity
Citation
Özdemir, Ö. (2010). Çocuklarda tekrarlayan baş ağrılarının sıklığının ve eşlik eden hastalıkların belirlenmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.