Çocuklarda ve Adölesanlarda Baş Ağrısının Yönetimi
Özet
Baş ağrısı, çocukluk ve adölesan döneminde en sık görülen nörolojik yakınmalardan biridir ve yaşam kalitesi, okul başarısı ve psikososyal işlevler üzerinde belirgin olumsuz etkiler yaratabilir. Bu bölümde çocuk ve adölesanlarda baş ağrısının epidemiyolojisi, patofizyolojisi, sınıflandırılması, klinik değerlendirme basamakları ve güncel tedavi yaklaşımları kapsamlı biçimde ele alınmaktadır. Primer baş ağrıları başta olmak üzere migren, gerilim tipi baş ağrısı ve küme baş ağrısının ayırıcı özellikleri, altta yatan nörobiyolojik mekanizmalar ve yaşa özgü klinik farklılıklar ayrıntılı olarak tartışılmaktadır. Ayrıca sekonder baş ağrılarında alarm semptomları, uygun görüntüleme ve laboratuvar tetkiklerine yönelik kanıta dayalı yaklaşımlar sunulmaktadır. Tedavi bölümünde akut atak yönetimi, profilaktik tedaviler, ilaç dışı tamamlayıcı yöntemler ve yaşam tarzı düzenlemeleri güncel kılavuzlar ışığında değerlendirilmektedir. Bu bölüm, klinisyenlere çocukluk çağı baş ağrılarının tanı ve yönetiminde pratik, sistematik ve bütüncül bir bakış açısı kazandırmayı amaçlamaktadır.
Referanslar
Hershey AD. Current approaches to the diagnosis and management of pediatric headache. Semin Pediatr Neurol. 2010 Sep;17(3):154-9. doi:10.1016/j.spen.2010.07.001.
Canpolat, & Kumandaş Ş. (2018). Approach to child admitted with headache and management of acute headaches. Türkiye Klinikleri Journal of Pediatric Sciences. 14(1), 82–98.
Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. doi:10.1177/0333102417738202.
Onofri A, Pensato U, Rosignoli, C et al (2023). Primary headache epidemiology in children and adolescents: A systematic review and meta-analysis. The Journal of Headache and Pain. 24(1), 8.
Nalçacıoğlu H, & Şenbil N, (2019). Okul çağı çocuklarında migren ve epizodik gerilim tipi başağrısı: Prevalans ve karşılaştırmalı klinik bulgular. Akdeniz Tıp Dergisi, 5(3), 453–459.
Ferrari MD, Goadsby PJ, Roon KI, et al. Migraine pathophysiology: lessons from functional neuroimaging. Lancet Neurol. 2006;5(6): 454-460.
Lauritzen M. Pathophysiology of the migraine aura: the spreading depression theory. Brain. 1994 Feb;117 (Pt 1):199-210. doi:10.1093/brain/117.1.199.
Goadsby PJ, Holland PR, Martins-Oliveira M, et al. Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev. 2017 Apr;97(2):553-622. doi: 10.1152/physrev.00034.2015. PMID: 28179394; PMCID: PMC5539409.
Edvinsson L, Haanes KA, Warfvinge K. Does inflammation have a role in migraine? Nature Reviews Neurology 2019 Aug;15(8):483-490. doi: 10.1038/s41582-019-0216-y. PMID: 31263254.
Ferrari MD, Goadsby PJ, Roon KI, et al. Triptans (serotonin 5-HT1B/1D agonists) in migraine: detailed results and methods of a meta-analysis of 53 trials. BMJ. 2001 Aug 4;323(7305):155–9.
Bendtsen L, Jensen R. Tension-type headache: the most common, but also the most neglected, headache disorder. Curr Opin Neurol. 2006 Jun;19(3):305–9. doi:10.1097/01.wco.0000227052.61070.38.
May A. Hypothalamic activation in cluster headache and other trigeminal autonomic cephalalgias. Curr Pain Headache Rep. 2006 Apr;10(2):147–53. doi:10.1007/s11916-006-0270-z.
Tunkel AR, Hasbun R, Bhimraj A, et al. Infectious Diseases Society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clinical Infectious Diseases. 2015 Mar 15;60(6):e1–e45. doi:10.1093/cid/civ017.
Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013 Sep 24;81(13):1159–65. doi:10.1212/WNL.0b013e3182a55f17.
Zemek L, Barrowman N, Freedman SB, Gravel J, et al. Association between early physical activity and persistent postconcussive symptoms in children and adolescents. JAMA. 2016 Dec 13;316(23):2504–14. doi:10.1001/jama.2016.17396.
Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology. 2002 Nov 26;59(10):1492-5. doi: 10.1212/01.wnl.0000029570.69134.1b. PMID: 12455560.
Hershey AD, Pediatric migraine: diagnosis and management. Neurologic Clinics. 2001; 19(4): 735–760 DOI: 10.1016/s0733-8619(05)70208-1
Rothner AD. Headaches in Children and Adolescents. In: Swaiman’s Pediatric Neurology, 2004. s. 901–914
Medina LS, Applegate KE, Blackmore CC, et al. American College of Radiology Appropriateness Criteria Expert Panel on Neurologic Imaging. Evidence-based guideline for neuroradiologic imaging in pediatric head trauma. Radiology. 2008;249(2):539–547.
Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160–1170. doi:10.1016/S0140-6736(09)61558-0
Hirtz D, Wilmshurst JM, Cheng YS, et al. Practice guideline update summary: Acute treatment of migraine in children and adolescents. Neurology. 2020;94(17):749–765.
Lewis DW, Ashwal S, Dahl G, Dorbad D, et al. Practice parameter: Evaluation of children and adolescents with recurrent headaches. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;59(4):490–498.
Oskoui M, Pringsheim T, Billinghurst L, et al. Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention. Neurology. 2019;93(11):500–509. doi:10.1212/WNL.0000000000008105
Kabbouche MA, Gilman DK, Hershey AD. Acute and preventive treatment of pediatric migraine: evidence-based review. Cephalalgia. 2016;36(11):1126–1138. doi:10.1177/0333102416630544
Ho TW, Connor KM, Zhang Y, et al. A randomized, controlled trial of rizatriptan in adolescents with migraine. Headache. 2012;52(6):813–825. doi:10.1111/j.1526-4610.2012.02147.x
Bachur R, Monuteaux MC, Neuman MI. Effectiveness of almotriptan in the emergency treatment of pediatric migraine: A retrospective cohort study. Headache. 2015;55(5):605–613.
Winner P, Linder S, Yanagihara T, Nett R, Lu M, Rothrock J. Sumatriptan nasal spray in adolescents with migraine: A randomized, double-blind, placebo-controlled study. Headache. 2015;55(7):927–935. doi:10.1111/head.12599
Lewis D, Lipton RB, Hall CB, et al. Efficacy and safety of zolmitriptan nasal spray in adolescents with migraine: a randomized controlled trial. Neurology. 2019;92(15):e1725–e1733.
Hershey AD, Kabbouche MA, Powers SW, et al. Efficacy and safety of sumatriptan-naproxen for the acute treatment of migraine in adolescents. Headache. 2019;59(2):192-203. doi:10.1111/head.13440.
Kramer MS, Barr RG, Leduc DG, et al. Promethazine use in children: a safety review. Pediatrics. 2015;135(3):e591–e597. doi:10.1542/peds.2014-3343.
Kabbouche MA, Gilman DK, Hershey AD. Acute and preventive treatment of pediatric migraine: evidence-based review. Cephalalgia. 2016;36(11):1126–1138. doi:10.1177/0333102416630544
Balestri M, Grosso S, Di Bartolo RM, et al. Intravenous valproate in children and adolescents with status migrainosus. J Headache Pain. 2007;8(6):361–364.
Powers SW, Coffey CS, Chamberlin LA, et al. Trial of amitriptyline, topiramate, and placebo for pediatric migraine. The New England Journal of Medicine 2017;376(2):115–124.
Winner P, Pearlman EM, Linder SL, et al. Topiramate for migraine prevention in pediatric patients: a randomized, double-blind, placebo-controlled trial. Neurology. 2015;84(7):634–641.
Lewis D, Yonker M, Winner P, et al. The pharmacology and clinical use of topiramate in pediatric migraine. Headache. 2018;58(2):181–190. doi:10.1111/head.13200.
Ueberall MA, Eberhardt M, Wenzel D, Mueller-Schwefe G. Propranolol in the prophylactic treatment of migraine in children and adolescents: A review. J Headache Pain. 2017;18(Suppl 1):45. doi:10.1186/s10194-017-0751
Gelfand, A. A. (2018). Pediatric Migraine. In Continuum: Lifelong Learning in Neurology – Child Neurology, 24(4), 1108–1126. https://doi.org/10.1212/CON.0000000000000635
Soriani S, Battistella PA, Boniver C. Flunarizine in childhood migraine prophylaxis: a double-blind, placebo-controlled, crossover study. J Headache Pain. 2016;17(1):16. doi:10.1186/s10194-016-0611-9.
Alstadhaug KB, Salvesen R, Bekkelund SI. Insomnia and circadian misalignment in migraine. Cephalalgia. 2018;38(4):503–509. doi:10.1177/0333102417721512.
Gelfand AA, Nye T, Goadsby PJ. Melatonin for the treatment of pediatric migraine. Pediatrics. 2015;135(3):494–501. doi:10.1542/peds.2014-3081.
Lewis D, Ashwal S, Dahl G, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Headache. 2016;56(9):1408-26. doi:10.1111/head.12817
Gelfand AA, Kabbouche MA, Hershey AD. Treatment of pediatric migraine: Acute and preventive medications. Headache. 2016;56(7):1196-212. doi:10.1111/head.12887
Cittadini E, Stuebner E, Goadsby PJ. Current and emerging medical treatments for cluster headache in children and adolescents. Pediatr Drugs. 2013;15(5):365–376. doi:10.1007/s40272-013-0035-3
Goadsby PJ. Pathophysiology of cluster headache: a trigeminal autonomic cephalalgia. Cephalalgia. 2021;41(13):1281–1290. doi:10.1177/03331024211032445
May A, Schwedt TJ, Magis D, et al. Cluster headache. Nature Reviews Disease Primers. 2016;2:16024. doi:10.1038/nrdp.2016.24
Evers S, Afra J, Frese A, Goadsby PJ, et al. European Federation of Neurological Societies guideline on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. Cephalalgia. 2020;40(7):621–644.
Goadsby PJ, de Coo IF, Silver N, et al. Trial of galcanezumab in prevention of episodic cluster headache. Brain. 2019;142(4):1228–38. doi:10.1093/brain/awz031
Trautmann E, Kröner-Herwig B, Gassmann J. Psychological treatment of recurrent headache in children and adolescents – a meta-analysis. European Journal of Pain. 2020;24(1):19–31. doi:10.1002/ejp.1474
Nestoriuc Y, Martin A, Rief W, Andrasik F. Biofeedback treatment for headache disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback. 2013;38(2):93–105.
Allen JR, Chambers CT, Reid GJ, McGrath PJ, et al. The role of relaxation training in pediatric pain management: review and meta-analysis. Pediatrics. 2019;144(2):e20190446. doi:10.1542/peds.2019-0446.
