Çocukluk ve Ergenlik Dönemi Baş Ağrıları ve Tedavi Yaklaşımları
Özet
Çocukluk ve ergenlik döneminde baş ağrısı, poliklinik ve acil servislere en sık başvuru nedenlerinden biridir. Görülme sıklığı yaşla birlikte artmakta ve puberteden sonra kız çocuklarında daha baskın hale gelmektedir. Baş ağrıları temel olarak primer (migren, gerilim tipi baş ağrısı vb.) ve sekonder (enfeksiyon, travma, tümör vb.) olarak ikiye ayrılmaktadır. Pediatrik acil başvurularının büyük kısmında viral enfeksiyonlar veya migren atakları saptanır. Teşhis sürecinde iyi bir anamnez ve fizik muayene genellikle yeterli olup, küçük çocuklarda ağrıyı tarif etmek için resim çizdirme veya Wong-Baker Ağrı Yüz Skalası gibi yöntemlerden yararlanılmaktadır. Tanıda kafa içi basınç artışı veya yapısal sorunlara işaret eden "kırmızı bayrak" (alarm verici) bulgular ile epilepsiyi taklit eden durumlar dikkatle incelenmelidir. Tedavi yaklaşımları ise primer veya sekonder nedene göre farklılık gösterir. İlaç dışı tedavilerde uyku düzeni, hidrasyon, sağlıklı beslenme ve tetikleyicilerden uzak durma gibi yaşam tarzı değişiklikleri migren ataklarını önlemede kritik role sahiptir. Akut atak tedavisinde ibuprofen ve parasetamol ilk basamakta tercih edilirken; dirençli vakalarda veya ergenlerde triptanlar kullanılabilir. Atak sıklığı ayda dörtten fazla olan ve günlük aktiviteleri engelleyen çocuklarda ise siproheptadin, topiramat, propranolol gibi ajanlarla en az 8-12 haftalık koruyucu tedavi planlanmaktadır.
Headache is one of the most common reasons for outpatient and emergency department visits during childhood and adolescence, with its prevalence increasing with age and becoming more dominant in girls after puberty. Headaches are primarily classified as primary (migraine, tension-type headache, etc.) and secondary (infection, trauma, tumor, etc.), with viral illnesses or migraine attacks identified in most pediatric emergency presentations. A thorough medical history and physical examination are generally sufficient for diagnosis; drawing methods or the Wong-Baker Pain Faces Scale are utilized for young children, while "red flag" (alarm) symptoms indicating increased intracranial pressure or structural issues and conditions mimicking epilepsy must be carefully evaluated. Treatment approaches vary based on whether the cause is primary or secondary. In non-pharmacological management, lifestyle changes such as regular sleep routines, adequate hydration, healthy nutrition, and avoiding triggers play a critical role in preventing migraine attacks. Oral ibuprofen and paracetamol are preferred as first-line options in acute attack treatment, whereas triptans can be used in resistant cases or adolescents. For children experiencing more than four attacks per month that impair daily activities, a prophylactic treatment of at least 8-12 weeks is planned using agents like cyproheptadine, topiramate, or propranolol.
Referanslar
Canpolat M, Kumandaş S. Baş ağrısı ile başvuran çocuğa yaklaşım ve akut baş ağrısı yönetimi. Türkiye Klinikleri Pediatrik Bilimler. 2018;14(1):82-98.
Nieswand V, Richter M, Gossrau G. Epidemiology of Headache in Children and Adolescents-Another Type of Pandemia. Curr Pain Headache Rep. 2020;24(10):62. doi: 10.1007/s11916-020-00892-6.
Kelly M, Strelzik J, Langdon R, et al. Pediatric headache: overview. Curr Opin Pediatr. 2018;30(6):748-754. doi: 10.1097/MOP.0000000000000688.
Poyrazoğlu HG, Kumandas S, Canpolat M, et al. The prevalence of migraine and tension-type headache among schoolchildren in Kayseri, Turkey: an evaluation of sensitivity and specificity using multivariate analysis. J Child Neurol. 2015;30(7):889-895. doi: 10.1177/0883073814549240.
Blume HK. Pediatric headache: a review. Pediatr Rev. 2012;33(12):562-576. doi: 10.1542/pir.33-12-562.
Kelman L. The biological basis of headache. Expert Rev Neurother. 2011;11(3):363-378. doi: 10.1586/ern.10.128.
Bigley GK. (1990). Headache. In Walker HK, Hall WD, Hurst JW (Eds.), Clinical Methods: The History, Physical, and Laboratory Examinations. (3rd ed. Chapter 54). Boston: Butterworths.
Chou DE. Secondary Headache Syndromes. Continuum (Minneap Minn). 2018;24(4, Headache):1179-1191. doi: 10.1212/CON.0000000000000640
Gelfand AA. Pediatric and Adolescent Headache. Continuum (Minneap Minn). 2018;24(4, Headache):1108-1136. doi: 10.1212/CON.0000000000000638.
Blume HK. Childhood Headache: A Brief Review. Pediatr Ann. 2017;46(4):e155-e165. doi: 10.3928/19382359-20170321-02.
Merison K, Victorio MCC. Approach to the Diagnosis of Pediatric Headache. Semin Pediatr Neurol. 2021;40:100920. doi: 10.1016/j.spen.2021.100920.
Wojaczyńska-Stanek K, Koprowski R, Wróbel Z, et al. Headache in children's drawings. J Child Neurol. 2008;23(2):184-191. doi: 10.1177/0883073807307985.
Panayiotopoulos CP. Elementary visual hallucinations, blindness, and headache in idiopathic occipital epilepsy: differentiation from migraine. J Neurol Neurosurg Psychiatry. 1999;66(4):536-540. doi: 10.1136/jnnp.66.4.536.
Langdon R, DiSabella MT. Pediatric Headache: An Overview. Curr Probl Pediatr Adolesc Health Care. 2017;47(3):44-65. doi: 10.1016/j.cppeds.2017.01.002.
Dao JM, Qubty W. Headache Diagnosis in Children and Adolescents. Curr Pain Headache Rep. 2018;22(3):17. doi: 10.1007/s11916-018-0675-7.
Papetti L, Capuano A, Tarantino S, et al. Headache as an emergency in children and adolescents. Curr Pain Headache Rep. 2015;19(3):3. doi: 10.1007/s11916-015-0480-5.
Spierings EL. Acute, subacute, and chronic headache. Otolaryngol Clin North Am. 2003;36(6):1095-107. doi: 10.1016/s0030-6665(03)00128-2.
Şenbil N, Gürer YK. Turkiye Klinikleri J Pediatr. 2004;13(4):254-260.
Ozge A, Termine C, Antonaci F, et al. Overview of diagnosis and management of paediatric headache. Part I: diagnosis. J Headache Pain. 2011;12(1):13-23. doi: 10.1007/s10194-011-0297-5.
Jacobs H, Singhi S, Gladstein J. Medical Comorbidities in Pediatric Headache. Semin Pediatr Neurol. 2016 Feb;23(1):60-67. doi: 10.1016/j.spen.2016.02.001
Ackley E, Clementi MA, Yonker ME. Headache and Sleep Disturbances in the Pediatric Population. Semin Pediatr Neurol. 2021;40:100924. doi: 10.1038/ng.3598.
Rajapakse T, Buchhalter J. The borderland of migraine and epilepsy in children. Headache. 2016;56(6):1071-1080. doi: 10.1111/head.12827.
Toldo I, Perissinotto E, Menegazzo F, et al. Comorbidity between headache and epilepsy in a pediatric headache center. J Headache Pain. 2010;11(3):235-240. doi: 10.1007/s10194-010-0191-6.
Gormley P, Anttila V, Winsvold BS, et al; International Headache Genetics Consortium. Meta-analysis of 375,000 individuals identifies 38 susceptibility loci for migraine. Nat Genet. 2016 Aug;48(8):856-866.
Raucci U, Della Vecchia N, Ossella C, et al. Management of Childhood Headache in the Emergency Department. Review of the Literature. Front Neurol. 2019;10:886. doi: 10.3389/fneur.2019.00886.
Yayıcı Köken Ö, Danış A, Yüksel D, et al. Pediatric headache: Are the red flags misleading or prognostic? Brain Dev. 2021;43(3):372-379. doi: 10.1016/j.braindev.2020.10.007.
Gurkas E, Karalok ZS, Taskın BD, et al. Brain magnetic resonance imaging findings in children with headache. Arch Argent Pediatr. 2017;115(6):e349-e355. doi: 10.5546/aap.2017.eng.e349.
Bayram E, Topcu Y, Karaoglu P, et al. Incidental white matter lesions in children presentıng with headache. Headache. 2013;53(6):970-976. doi: 10.1111/head.12089.
Aydin H, Bucak IH, Geyik M. Vitamin B12 and folic acid levels in pediatric migraine patients. Acta Neurol Belg. 2021;121(6):1741-1744. doi: 10.1007/s13760-020-01491-3.
Poyrazoğlu HG, Öztürk AB. Predictive value of laboratory parameters in childhood migraine. Acta Neurol Belg. 2020;120(4):907-914. doi: 10.1007/s13760-019-01106-6.
Ghorbani Z, Togha M, Rafiee P, et al. Vitamin D in migraine headache: a comprehensive review on literature. Neurol Sci. 2019;40(12):2459-2477. doi: 10.1007/s10072-019-04021-z.
Paruthi S, Brooks LJ, D'Ambrosio C, et al. Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):785-786. doi: 10.5664/jcsm.5866.
Richer L, Billinghurst L, Linsdell MA, et al. Drugs for the acute treatment of migraine in children and adolescents. Cochrane Database Syst Rev. 2016;4(4):CD005220. doi: 10.1002/14651858.
Kim H, Byun SH, Kim JS, et al. Comparison of flunarizine and topiramate for the prophylaxis of pediatric migraines. Eur J Paediatr Neurol. 2013;17(1):45-49. doi: 10.1016/j.ejpn.2012.10.001.
