Download PDF
Journal of Pediatric Neurology 2021; 19(05): 303-311
DOI: 10.1055/s-0040-1721460
Original Article

Reassessment of Pediatric Tension-Type Headaches

Michael Vaiman 
1   Department of Otorhinolaryngology, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel
,
Kadri Mametov 
2   Emergency Department, Crimean Republican Center for Disaster Medicine and Emergency Medical Aid, Simferopol, Russia
,
Yulia Roitblat 
3   Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
,
Michael Abba 
4   Department of Oral and Maxillofacial Surgery, Barzilai Medical Center, Ashkelon, Israel
,
Liliia Nehuliaieva 
5   Department of Pediatrics, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
,
Maya Foonberg 
3   Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
6   Department of Advanced Research and Design, Milken Community High School, Los Angeles, California, United States
,
Charles Frank 
3   Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
6   Department of Advanced Research and Design, Milken Community High School, Los Angeles, California, United States
,
Vitalii B. Kaliberdenko 
7   Department of Internal Medicine, V.I. Vernadsky Crimean Federal University, Simferopol, Russia
,
Michael Shterenshis 
3   Science Research Department, Alexander Muss High School in Israel affiliated with Alexander Muss Institute for Israel Education, Hod HaSharon, Israel
› Author Affiliations
› Further Information
    Permissions and Reprints

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


Publication History

Received: 18 May 2020

Accepted: 12 August 2020

Article published online:
02 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Stein MT, Trauner D. The child with a stiff neck. Clin Pediatr (Phila) 1982; 21 (09) 559-563
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 7 Topka H. [Meningism] (in German). 2018; 86 (05) 287-289
    PubMedGoogle Scholar
  • 8 Zomorrodi A, Wald ER. Sydenham's chorea in western Pennsylvania. Pediatrics 2006; 117 (04) e675-e679
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Wilbur C, Bitnun A, Kronenberg S. et al. PANDAS/PANS in childhood:controversies and evidence. Paediatr Child Health 2019; 24 (02) 85-9
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 15 Kwak C, Vuong KD, Jankovic J. Migraine headache in patients with Tourette syndrome. Arch Neurol 2003; 60 (11) 1595-1598
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 21 Seshia SS. Chronic daily headache in children and adolescents. Can J Neurol Sci 2004; 31 (03) 319-323
    CrossrefPubMedGoogle Scholar
  • 22 Anttila P. Tension-type headache in children and adolescents. Curr Pain Headache Rep 2004; 8 (06) 500-504
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 29 Kelly M, Strelzik J, Langdon R, DiSabella M. Pediatric headache: overview. Curr Opin Pediatr 2018; 30 (06) 748-754
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 32 Gladstein J, Holden EW. Chronic daily headache in children and adolescents: a 2-year prospective study. Headache 1996; 36 (06) 349-351
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 38 Itoh Y, Hamada H, Imai T. et al. Antinuclear antibodies in children with chronic nonspecific complaints. Autoimmunity 1997; 25 (04) 243-250
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 40 Zhu R, He Z, Ren Y. Idiopathic hypertrophic craniocervical pachymeningitis. Eur Spine J 2015; 24 (Suppl. 04) S633-S635
    CrossrefPubMedGoogle Scholar
  • 41 Hahn LD, Fulbright R, Baehring JM. Hypertrophic pachymeningitis. J Neurol Sci 2016; 367: 278-283
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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 DOI: 10.3389/fped.2020.00176.
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 49 Hormati A, Akbari N, Sharifipour E. et al. Migraine and gastric disorders: are they associated?. J Res Med Sci 2019; 24: 60
    CrossrefPubMedGoogle Scholar
  • 50 Alexiou GA, Argyropoulou MI. Neuroimaging in childhood headache: a systematic review. Pediatr Radiol 2013; 43 (07) 777-784
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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 DOI: 10.1002/jmri.25373.
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 54 Penfield W, McNaughton F. Dural headache and innervation of the dura mater. Arch Neurol Psychiatry 1940; 44: 43-75
    CrossrefPubMedGoogle Scholar
  • 55 Williamson DJ, Hargreaves RJ. Neurogenic inflammation in the context of migraine. Microsc Res Tech 2001; 53 (03) 167-178
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 58 Gaul C, Meßlinger K, Holle-Lee D, Neeb L. [Pathophysiology of Headaches] (In German). Dtsch Med Wochenschr 2017; 142 (06) 402-408
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 60 Hershey AD. Pediatric headache: update on recent research. Headache 2012; 52 (02) 327-332
    CrossrefPubMedGoogle Scholar