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Children
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Pediatric Headaches: Diagnostic and Therapeutic Issues
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Pediatric Headaches: Diagnostic and Therapeutic Issues

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neurology & Neurodevelopmental Disorders".

Deadline for manuscript submissions: 5 February 2025 | Viewed by 6280

Special Issue Editor

Prof. Dr. Alberto Maria Cappellari

E-Mail Website
Guest Editor
Department of Neuroscience and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
Interests: clinical pediatric neurology; including epilepsy; headache; movement disorders and neuromuscular diseases

Special Issue Information

Dear Colleagues,

Headaches are one of the most frequent causes of admission to the pediatric emergency department or ambulatory clinic. Headaches can be worrisome for patients, their parents and clinicians owing to the variety of underlying etiologies, both benign and serious. A thorough yet focused approach is required in diagnosing and treating children with headaches. However, many clinicians are not familiar with a focused approach to headaches, which can result in difficulty with decision making regarding further testing, such as neuroimaging, and treatment options.

In this Special Issue, we aim to review the clinician’s approach to children with headaches. The Special Issue is organized to address the diagnosis and treatment of common and less common pediatric headaches in clinical practice.

Prof. Dr. Alberto Maria Cappellari
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • children
  • adolescents
  • headache
  • migraine
  • red flags

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Published Papers (5 papers)

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Research

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12 pages, 1442 KiB  
Article
Pediatric Migraine and Visual Cortical Excitability: A Prospective Observational Study with Sound-Induced Flash Illusions
by Salvatore Di Marco, Laura Pilati, Angelo Torrente, Simona Maccora, Andrea Santangelo, Giuseppe Cosentino, Edvige Correnti, Vincenzo Raieli, Brigida Fierro and Filippo Brighina
Children 2024, 11(4), 394; https://doi.org/10.3390/children11040394 - 26 Mar 2024
Viewed by 999
Abstract
The pathophysiological mechanisms underlying migraine are more difficult to investigate in children than in the adult population. Abnormal cortical excitability turns out to be one of the most peculiar aspects of migraine, accounting for the manifestations of migraine attacks. Recently, visual cortical excitability [...] Read more.
The pathophysiological mechanisms underlying migraine are more difficult to investigate in children than in the adult population. Abnormal cortical excitability turns out to be one of the most peculiar aspects of migraine, accounting for the manifestations of migraine attacks. Recently, visual cortical excitability has been explored effectively in adult migraineurs with a technique based on cross-modal audio-visual illusions (with sound-induced flash illusions (SIFIs) being reduced in migraineurs compared to non-migraineur subjects). On such a basis, in this study, we investigated visual cortical excitability in children with migraine using SIFIs using combinations of visual and sound stimuli presented randomly. We evaluated 26 children with migraine without aura and 16 healthy children. Migraineurs did not differ from the age-matched healthy subjects regarding fission or fusion illusions but perceived more flashes in trials of multiple flashes with or without beeps. The higher number of SIFIs in migraineur children compared to adults may be due to a greater propensity of visual stimulation to be driven by auditory stimuli (i.e., acoustic dominance). The increased ability to perceive flashes reveals a hyperfunctional visual cortex, demonstrating that the use of SIFIs is a valid tool for assessing visual cortical responsiveness even in pediatric migraine. Full article
(This article belongs to the Special Issue Pediatric Headaches: Diagnostic and Therapeutic Issues)
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10 pages, 287 KiB  
Article
How Can Specialist Advice Influence the Neuroimaging Practice for Childhood Headache in Emergency Department?
by Alberto M. Cappellari, Gaia Bruschi, Gisella B. Beretta, Maria T. Molisso and Giuseppe Bertolozzi
Children 2023, 10(12), 1837; https://doi.org/10.3390/children10121837 - 22 Nov 2023
Viewed by 1189
Abstract
Differentiating between primary and secondary headaches can be challenging, especially in the emergency department (ED). Since symptoms alone are inadequate criteria for distinguishing between primary and secondary headaches, many children with headaches undergo neuroimaging investigations, such as brain CT and MRI. In various [...] Read more.
Differentiating between primary and secondary headaches can be challenging, especially in the emergency department (ED). Since symptoms alone are inadequate criteria for distinguishing between primary and secondary headaches, many children with headaches undergo neuroimaging investigations, such as brain CT and MRI. In various studies, the frequency of neuroimaging utilization is influenced by several factors, including teaching status, ownership, metropolitan area, insurance status, and ethnicity of patients. However, only a few studies have considered the role of specialist consultations in ordering neuroimaging studies on childhood headaches. We report the contributions of different specialists to the evaluation of children with headaches admitted to the ED and their influence on neuroimaging decisions. We retrospectively reviewed the medical reports of paediatric patients who presented with headaches to the paediatric ED of the Ospedale Maggiore Policlinico of Milano between January 2017 and January 2022. Overall, 890 children with headaches were evaluated (mean age: 10.0 years; range: 1 to 17 years). All patients were examined by the ED paediatricians, while specialist consultations were required for 261 patients, including 240 neurological (92.0%), 46 ophthalmological (17.6%), and 20 otorhinolaryngological (7.7%) consultations. Overall, 173 neuroimaging examinations were required, of which 51.4 and 48.6% were ordered by paediatricians and neurologists, respectively. In particular, paediatricians required 61.4% of brain CT scans, and neurologists required 92.0% of brain MRI scans. In conclusion, paediatricians were responsible for the management of most children with headaches admitted to the ED, while specialist consultations were required only in about a third of the cases. Although there was no significant difference in the number of neuroimaging studies ordered by specialists, brain CT scans were most often used by paediatricians, and MRI scans by neurologists. Full article
(This article belongs to the Special Issue Pediatric Headaches: Diagnostic and Therapeutic Issues)
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Graphical abstract

17 pages, 1634 KiB  
Communication
Neuromodulation in Pediatric Migraine using Repetitive Neuromuscular Magnetic Stimulation: A Feasibility Study
by Corinna Börner-Schröder, Magdalena Lang, Giada Urban, Erik Zaidenstadt, Jacob Staisch, Ari Hauser, Iris Hannibal, Kristina Huß, Birgit Klose, Matthias F. Lechner, Nico Sollmann, Mirjam N. Landgraf, Florian Heinen and Michaela V. Bonfert
Children 2023, 10(11), 1764; https://doi.org/10.3390/children10111764 - 30 Oct 2023
Viewed by 1428
Abstract
Migraine has a relevant impact on pediatric health. Non-pharmacological modalities for its management are urgently needed. This study assessed the safety, feasibility, acceptance, and efficacy of repetitive neuromuscular magnetic stimulation (rNMS) in pediatric migraine. A total of 13 patients with migraine, ≥6 headache [...] Read more.
Migraine has a relevant impact on pediatric health. Non-pharmacological modalities for its management are urgently needed. This study assessed the safety, feasibility, acceptance, and efficacy of repetitive neuromuscular magnetic stimulation (rNMS) in pediatric migraine. A total of 13 patients with migraine, ≥6 headache days during baseline, and ≥1 myofascial trigger point in the upper trapezius muscles (UTM) received six rNMS sessions within 3 weeks. Headache frequency, intensity, and medication intake were monitored using headache calendars; headache-related impairment and quality of life were measured using PedMIDAS and KINDL questionnaires. Muscular involvement was assessed using pressure pain thresholds (PPT). Adherence yielded 100%. In 82% of all rNMS sessions, no side effects occurred. All participants would recommend rNMS and would repeat it. Headache frequency, medication intake, and PedMIDAS scores decreased from baseline to follow-up (FU), trending towards statistical significance (p = 0.089; p = 0.081, p = 0.055). A total of 7 patients were classified as responders, with a ≥25% relative reduction in headache frequency. PPT above the UTM significantly increased from pre- to post-assessment, which sustained until FU (p = 0.015 and 0.026, respectively). rNMS was safe, feasible, well-accepted, and beneficial on the muscular level. The potential to reduce headache-related symptoms together with PPT changes of the targeted UTM may underscore the interplay of peripheral and central mechanisms conceptualized within the trigemino-cervical complex. Full article
(This article belongs to the Special Issue Pediatric Headaches: Diagnostic and Therapeutic Issues)
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6 pages, 453 KiB  
Communication
High CCL2 Levels Detected in CSF of Patients with Pediatric Pseudotumor Cerebri Syndrome
by Jacob Genizi, Lotan Berger, Muhammad Mahajnah, Yulia Shlonsky, Orit Golan-Shany, Azriel Romem, Ayelet Halevy, Keren Nathan, Rajech Sharkia, Abdelnaser Zalan, Aharon Kessel and Rony Cohen
Children 2023, 10(7), 1122; https://doi.org/10.3390/children10071122 - 28 Jun 2023
Cited by 1 | Viewed by 1059
Abstract
Pseudotumor cerebri (PTC) is a disorder characterized by increased intracranial pressure in the absence of a structural lesion or other identifiable cause. Cytokines, which are involved in the regulation of immune responses and inflammation, have been implicated in the pathogenesis of PTC. In [...] Read more.
Pseudotumor cerebri (PTC) is a disorder characterized by increased intracranial pressure in the absence of a structural lesion or other identifiable cause. Cytokines, which are involved in the regulation of immune responses and inflammation, have been implicated in the pathogenesis of PTC. In a prospective, cross-sectional study at three centers in Israel, we analyzed cerebrospinal fluid (CSF) samples from 60 children aged 0.5–18 years, including 43 children with a definitive diagnosis of PTC and a control group of 17 children. Levels of IL-4, IL-10, IL-17, CCL2, CCL7, CCL8, CCL13, BDNF, and IFN-γ were measured using ELISA kits. Levels of CCL2 were significantly higher in the PTC group compared to the control group (p < 0.05), with no other significant differences in the measured cytokines between the two groups. The groups did not differ significantly in clinical presentation, imaging, treatment, or ophthalmic findings. Our findings provide preliminary evidence that CCL2 may be involved in the pathogenesis of PTC and may serve a potential target for therapy in PTC. Full article
(This article belongs to the Special Issue Pediatric Headaches: Diagnostic and Therapeutic Issues)
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Review

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12 pages, 267 KiB  
Review
Chronic Pediatric Headache as a Manifestation of Shunt Over-Drainage and Slit Ventricle Syndrome in Patients Harboring a Cerebrospinal Fluid Diversion System: A Narrative Literature Review
by Dimitrios Panagopoulos, Maro Gavra, Efstathios Boviatsis, Stefanos Korfias and Marios Themistocleous
Children 2024, 11(5), 596; https://doi.org/10.3390/children11050596 - 15 May 2024
Viewed by 931
Abstract
The main subject of the current review is a specific subtype of headache, which is related to shunt over-drainage and slit ventricle syndrome, in pediatric patients harboring an implanted shunt device for the management of hydrocephalus. This clinical entity, along with its impairment [...] Read more.
The main subject of the current review is a specific subtype of headache, which is related to shunt over-drainage and slit ventricle syndrome, in pediatric patients harboring an implanted shunt device for the management of hydrocephalus. This clinical entity, along with its impairment regarding the quality of life of the affected individuals, is generally underestimated. This is partly due to the absence of universally agreed-upon diagnostic criteria, as well as due to a misunderstanding of the interactions among the implicated pathophysiological mechanisms. A lot of attempts have been performed to propose an integrative model, aiming at the determination of all the offending mechanisms of the shunt over-drainage syndrome, as well as the determination of all the clinical characteristics and related symptomatology that accompany these secondary headaches. This subcategory of headache, named postural dependent headache, can be associated with nausea, vomiting, and/or radiological signs of slim ventricles and/or subdural collections. The ultimate goal of our review is to draw clinicians’ attention, especially that of those that are managing pediatric patients with permanent, long-standing, ventriculoperitoneal, or, less commonly, ventriculoatrial shunts. We attempted to elucidate all clinical and neurological characteristics that are inherently related to this type of headache, as well as to highlight the current management options. This specific subgroup of patients may eventually suffer from severe, intractable headaches, which may negatively impair their quality of daily living. In the absence of any other clinical condition that could be incriminated as the cause of the headache, shunt over-drainage should not be overlooked. On the contrary, it should be seriously taken into consideration, and its management should be added to the therapeutic armamentarium of such cases, which are difficult to be handled. Full article
(This article belongs to the Special Issue Pediatric Headaches: Diagnostic and Therapeutic Issues)
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