Reassessment of Pediatric Tension-Type Headaches

Abstract

A retrospective multicenter chart review was conducted with the objective of evaluating the hypothesis that certain cases diagnosed as tension-type headache (TTH) in pediatric neurology are not stress-related or central sensitization-related conditions but may mimic an autoimmune disorder of the dura mater. Of the 29,642 patient charts reviewed, 12,424 charts (42%) were excluded because of incomplete data and 17,218 cases were analyzed. For all the 29,642 charts, TTH or chronic daily headaches were diagnosed in 29.2% of cases. Among the 17,218 cases subjected to detailed diagnostic procedures, TTH was diagnosed in only 5%. In 7,044 cases, the initial diagnosis of TTH was changed to headache attributed to infection (87.4%), which was supported by the presence of meningeal signs, high antistreptolysin-O titers, and, in 46% of cases, magnetic resonance imaging (MRI)-detected thickening of the cranial dura mater. The initial diagnosis of migraine was confirmed in 87.7% of cases (8,034/9,162). In some cases of treatment-resistant pediatric recurrent headaches, which are initially diagnosed as TTH, a secondary type of headache may be suspected as the underlying cause. Usually this type of headache has streptococcal infection-related laboratory findings, the meninges as the site of the lesion, and meningism as the clinical presentation.

Keywords

tension-type headache - meningism - streptococcal infection

Publikationsverlauf

Eingereicht: 18. Mai 2020

Angenommen: 12. August 2020

Artikel online veröffentlicht:
02. Dezember 2020

• References

• 1 Law EF, Powers SW, Blume H, Palermo TM. Screening family and psychosocial risk in pediatric migraine and tension-type headache: validation of the psychosocial assessment tool (PAT). Headache 2019; 59 (09) 1516-1529
• 2 Sarioglu B, Erhan E, Serdaroglu G, Doering BG, Erermis S, TutuncuoGlu S. Tension-type headache in children: a clinical evaluation. Pediatr Int 2003; 45 (02) 186-189
• 3 Karli N, Zarifoglu M, Calisir N, Akgoz S. Comparison of pre-headache phases and trigger factors of migraine and episodic tension-type headache: do they share similar clinical pathophysiology?. Cephalalgia 2005; 25 (06) 444-451
• 4 Martin PR, Mackenzie S, Bandarian-Balooch S. et al. Enhancing cognitive-behavioural therapy for recurrent headache: design of a randomised controlled trial. BMC Neurol 2014; 14: 233
• 5 Stein MT, Trauner D. The child with a stiff neck. Clin Pediatr (Phila) 1982; 21 (09) 559-563
• 6 de Vries TW, Teeuw AH, Heymans HS. [Meningism and meningitis, variations on a classical theme] (in Dutch). Ned Tijdschr Geneeskd 1989; 133 (16) 801-803
• 7 Topka H. [Meningism] (in German). 2018; 86 (05) 287-289
• 8 Zomorrodi A, Wald ER. Sydenham's chorea in western Pennsylvania. Pediatrics 2006; 117 (04) e675-e679
• 9 Kim SW, Grant JE, Kim SI. et al. A possible association of recurrent streptococcal infections and acute onset of obsessive-compulsive disorder. J Neuropsychiatry Clin Neurosci 2004; 16 (03) 252-260
• 10 Rizzo R, Gulisano M, Pavone P, Fogliani F, Robertson MM. Increased antistreptococcal antibody titers and anti-basal ganglia antibodies in patients with Tourette syndrome: controlled cross-sectional study. J Child Neurol 2006; 21 (09) 747-753
• 11 Pavone P, Bianchini R, Parano E. et al. Anti-brain antibodies in PANDAS versus uncomplicated streptococcal infection. Pediatr Neurol 2004; 30 (02) 107-110
• 12 Wilbur C, Bitnun A, Kronenberg S. et al. PANDAS/PANS in childhood:controversies and evidence. Paediatr Child Health 2019; 24 (02) 85-9
• 13 Almazov I, Brand N. Meningismus is a commonly overlooked finding in tension-type headache in children and adolescents. J Child Neurol 2006; 21 (05) 423-425
• 14 McAbee GN, Morse AM, Assadi M. Pediatric aspects of headache classification in the International Classification of Headache Disorders-3 (ICHD-3 beta version). Curr Pain Headache Rep 2016; 20 (01) 7
• 15 Kwak C, Vuong KD, Jankovic J. Migraine headache in patients with Tourette syndrome. Arch Neurol 2003; 60 (11) 1595-1598
• 16 Ghosh D, Rajan PV, Das D, Datta P, Rothner AD, Erenberg G. Headache in children with Tourette syndrome. J Pediatr 2012; 161 (02) 303-7.e6
• 17 Almazov I, Burke M, Mosek A. Meningismus in children with chronic headache is most likely due to streptococcal infection. Med Hypotheses 2014; 82 (04) 490-492
• 18 Tattevin P, Le Tulzo Y, Minjolle S. et al. Increasing incidence of severe Epstein-Barr virus-related infectious mononucleosis: surveillance study. J Clin Microbiol 2006; 44 (05) 1873-1874
• 19 Lee SH, Lee JJ, Kwon Y, Kim JH, Sohn JH. Clinical implications of associations between headache and gastrointestinal disorders: a study using the hallym smart clinical data warehouse. Front Neurol 2017; 8: 526
• 20 Seshia SS. Mixed migraine and tension-type: a common cause of recurrent headache in children. Can J Neurol Sci 2004; 31 (03) 315-318
• 21 Seshia SS. Chronic daily headache in children and adolescents. Can J Neurol Sci 2004; 31 (03) 319-323
• 22 Anttila P. Tension-type headache in children and adolescents. Curr Pain Headache Rep 2004; 8 (06) 500-504
• 23 Wolstein JR, Seshia SS, Haese P, Adams C, Booth FA, Reggin JD. Inter-observer agreement in the diagnosis of childhood headache. Headache 1994; 34 (08) 467-470
• 24 Wager J, Hirschfeld G, Zernikow B. Tension-type headache or migraine? Adolescents' pain descriptions are of little help. Headache 2013; 53 (02) 322-332
• 25 Rossi LN, Cortinovis I, Menegazzo L, Brunelli G, Bossi A, Macchi M. Classification criteria and distinction between migraine and tension-type headache in children. Dev Med Child Neurol 2001; 43 (01) 45-51
• 26 Seshia SS, Abu-Arafeh I, Hershey AD. Tension-type headache in children: the Cinderella of headache disorders!. Can J Neurol Sci 2009; 36 (06) 687-695
• 27 Akaishi T, Kobayashi J, Abe M. et al. Sensitivity and specificity of meningeal signs in patients with meningitis. J Gen Fam Med 2019; 20 (05) 193-198
• 28 Mehndiratta M, Nayak R, Garg H, Kumar M, Pandey S. Appraisal of Kernig's and Brudzinski's sign in meningitis. Ann Indian Acad Neurol 2012; 15 (04) 287-288
• 29 Kelly M, Strelzik J, Langdon R, DiSabella M. Pediatric headache: overview. Curr Opin Pediatr 2018; 30 (06) 748-754
• 30 Mitsikostas DD, Ashina M, Craven A. et al; EHF Committee. European Headache Federation consensus on technical investigation for primary headache disorders. J Headache Pain 2015; 17: 5
• 31 Martens D, Oster I, Gottschlling S. et al. Cerebral MRI and EEG studies in the initial management of pediatric headaches. Swiss Med Wkly 2012; 142: w13625
• 32 Gladstein J, Holden EW. Chronic daily headache in children and adolescents: a 2-year prospective study. Headache 1996; 36 (06) 349-351
• 33 Kang BS, Lee J, Choi JH, Kwon HH, Kang JW. Clinical manifestations of headache in children younger than 7 years. Korean J Pediatr 2018; 61 (11) 355-361
• 34 Zernikow B, Wager J, Hechler T. et al. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients. BMC Pediatr 2012; 12: 54
• 35 Quagliariello A, Del Chierico F, Russo A. et al. Gut microbiota profiling and gut-brain crosstalk in children affected by pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Front Microbiol 2018; 9: 675
• 36 Fernández Ibieta M, Ramos Amador JT, Auñón Martínc I, Marín MA, González Tomé MI, Simón de Las Heras R. [Neuropsychiatric disorders associated with streptococci: a case report] (in Spanish). An Pediatr (Barc) 2005; 62 (05) 475-478
• 37 Maina G, Albert U, Bogetto F. et al. Anti-brain antibodies in adult patients with obsessive-compulsive disorder. J Affect Disord 2009; 116 (03) 192-200
• 38 Itoh Y, Hamada H, Imai T. et al. Antinuclear antibodies in children with chronic nonspecific complaints. Autoimmunity 1997; 25 (04) 243-250
• 39 Morshed SA, Parveen S, Leckman JF. et al. Antibodies against neural, nuclear, cytoskeletal, and streptococcal epitopes in children and adults with Tourette's syndrome, Sydenham's chorea, and autoimmune disorders. Biol Psychiatry 2001; 50 (08) 566-577
• 40 Zhu R, He Z, Ren Y. Idiopathic hypertrophic craniocervical pachymeningitis. Eur Spine J 2015; 24 (Suppl. 04) S633-S635
• 41 Hahn LD, Fulbright R, Baehring JM. Hypertrophic pachymeningitis. J Neurol Sci 2016; 367: 278-283
• 42 Cação G, Calejo M, Alves JE. et al. Clinical features of hypertrophic pachymeningitis in a center survey. Neurol Sci 2019; 40 (03) 543-551
• 43 Sakairi T, Sakurai N, Nakasatomi M. et al. Hypertrophic pachymeningitis associated with antineutrophil cytoplasmic antibody-associated vasculitis: a case series of 15 patients. Scand J Rheumatol 2019; 48 (03) 218-224
• 44 Cea G, Barria S, Leiderman V, Cartier L. [Autoimmune chronic meningitis secondary to pneumococcal meningitis. Report of one case] (in Spanish). Rev Med Chil 2019; 147 (06) 803-807
• 45 Nóbrega PR, Morais NMM, Braga-Neto P. et al. NMDAR encephalitis associated with acute chikungunya virus infection: a new trigger?. Front Pediatr 2020; 8: 176
• 46 Wegener-Panzer A, Cleaveland R, Wendel EM. et al. Clinical and imaging features of children with autoimmune encephalitis and MOG antibodies. Neurol Neuroimmunol Neuroinflamm 2020; 7 (04) e731
• 47 Jiménez-Zarazúa O, Martínez-Rivera MA, González-Carrillo PL. et al. Headache, delirium or encephalitis? A case of residual mutism secondary to anti-NMDA receptor encephalitis. Case Rep Neurol 2019; 11 (03) 330-343
• 48 Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A. Gastrointestinal disorders associated with migraine: a comprehensive review. World J Gastroenterol 2016; 22 (36) 8149-8160
• 49 Hormati A, Akbari N, Sharifipour E. et al. Migraine and gastric disorders: are they associated?. J Res Med Sci 2019; 24: 60
• 50 Alexiou GA, Argyropoulou MI. Neuroimaging in childhood headache: a systematic review. Pediatr Radiol 2013; 43 (07) 777-784
• 51 Chen H, Zhang W, Jing J. et al. The clinical and imaging features of hypertrophic pachymeningitis: a clinical analysis on 22 patients. Neurol Sci 2019; 40 (02) 269-274
• 52 Tan K, Wijaya L, Chiew HJ. et al. Diffusion-weighted MRI abnormalities in an outbreak of Streptococcus agalactiae Serotype III, multilocus sequence type 283 meningitis. J Magn Reson Imaging 2017; 45 (02) 507-514
• 53 Héritier S, Torchin H, Verstraete A. et al. [Pediatric lumbar puncture: indications, execution and complications] (in French). Rev Prat 2018; 68 (04) 426-430
• 54 Penfield W, McNaughton F. Dural headache and innervation of the dura mater. Arch Neurol Psychiatry 1940; 44: 43-75
• 55 Williamson DJ, Hargreaves RJ. Neurogenic inflammation in the context of migraine. Microsc Res Tech 2001; 53 (03) 167-178
• 56 Koyuncu Irmak D, Kilinc E, Tore F. Shared fate of meningeal mast cells and sensory neurons in migraine. Front Cell Neurosci 2019; 13: 136
• 57 Levy D, Labastida-Ramirez A, MaassenVanDenBrink A. Current understanding of meningeal and cerebral vascular function underlying migraine headache. Cephalalgia 2019; 39 (13) 1606-1622
• 58 Gaul C, Meßlinger K, Holle-Lee D, Neeb L. [Pathophysiology of Headaches] (In German). Dtsch Med Wochenschr 2017; 142 (06) 402-408
• 59 Almazov I, Brand N. Meningeal symptoms of chronic headaches in children and adolescents—a new approach to diagnosis and treatment. Eur J Neurol 2003; 10 (Suppl. 01) 197
• 60 Hershey AD. Pediatric headache: update on recent research. Headache 2012; 52 (02) 327-332