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Idiopathic Headache in Children Under
Six Years of Age: A Follow-Up Study
Balottin U, Termine C, Nicoli F, et al.
Posted: August 2005  
Headache 2005;45:705-715

Objective:   To assess the evolution of idiopathic headache with early onset and to investigate the influence of early somatic disorders, "life events", and psychiatric disorders on the onset and the course of headache. We also studied the possible prognostic role of gender, headache diagnosis at onset, and history of headache in family members on the course of headache. We also investigated the applicability of the ICHD-II criteria to idiopathic headache in preschool children.

Methods:   Prospective evaluation of 25 consecutive headache patients referred before the age of 6 years. Headache diagnosis was based on the IHS 1988 criteria, on the ICHD-II criteria, and on "alternative" clinical criteria (e.g. duration less than 1 hour in migraine without aura, less than 30 minutes in tension-type headache). All patients were assessed by a structured interview to detect early developmental disorders (e.g. feeding difficulties or sleep disorders) and "life events" (e.g. parents’ separation and others according to DSM-IV). All patients underwent clinical observations and assessment of psychiatric comorbidity by means of interviews and the Child Behavior Check List. All the above-mentioned evaluations were performed at recruitment and at the end of the follow-up period.

Conclusions:   Our results suggest that the ICHD-II criteria are too restrictive to allow the classification of migraine without aura and tension-type headache in preschool children. Nevertheless, a diagnosis based on these criteria was possible in all the patients with headache persistence at the end of several years’ follow-up. We found a significant association between early somatic disorders and persistence of headache and also between the presence of psychiatric disorders at the end of follow-up and the persistence of headache. "Life events", on the other hand, while not showing a statistically significant association with the evolution of the headache, may nevertheless influence the course of the headache in some patients. Our results suggest that environmental and psychological factors play an important role in idiopathic headache with onset in preschool age, and thus that the diagnostic-therapeutic approach must take these factors into account.