소아 청소년 두통에 의한 장애와 예측인자

Abstract

Objectives: The aim of this study is to estimate headache-related disability and to identify predictor of disability in children and adolescent with headache. In addition, this is to assess the improvement of disability after treatment.

Methods: I conducted a retrospective analysis of clinical records of children and adolescents aged between 6 and 18 years who were presented with headache at the Chosun university hospital between January 2010 and December 2014. Headache-related disabilities were valuated using the 6-question Pediatric Migraine Disability Assessment(PedMIDAS). Data regarding age, sex, headache type, frequency, duration, severity and duration of symptoms before presentation were obtained for each patient. The headaches were classified according to the International Classification of Headaches Disorders-Ⅱ (ICHD-Ⅱ).

Results: A total of 307 patients were identified : 117 boys and 190 girls with a mean age of 11.3 years (range 6-18 years). About 17% of patients had a grade Ⅲ-Ⅳ disability. There is a trend towards more severe disabilities in older age groups, especially in the 16-18 year-olds. The migraine patients have the highest PedMIDAS scores (19.9±26.6), whereas, the other headache patients have the lowest scores (7.9±16.0). This is higher score and severe disability at home activity (3.5±7.4) than school (2.4±4.2) and play, social or leisure activity (2.9±7.7). The predictors of disability due to headache are migraine, frequent headache and longer duration of symptom before presentation. Mean PedMIDAS score is significantly improved by treatment(P=0.002).

Conclusion: A considerable number of children and adolescents with headache had a moderate to severe disability. There is a trend towards more severe disabilities in older age groups. The migraine patients have the worst disability. The predictors of disability due to headache are migraine, frequent headache and longer duration of symptom before presentation. This study demonstrated that proper preventive treatment can improve the quality of life of pediatric headache patients.