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Pediatric-onset trigeminal autonomic cephalalgias: A systematic review and meta-analysis
Cephalalgia ( IF 4.9 ) Pub Date : 2021-08-18 , DOI: 10.1177/03331024211027560
Ankita Ghosh 1, 2 , Emma Silva 3 , Mark J Burish 4
Affiliation  

Background and objective

There are five headache disorders composing the trigeminal autonomic cephalalgias (cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), and hemicrania continua). Little is known about these disorders in the pediatric population. The objectives of this study are to report the full age ranges of pediatric trigeminal autonomic cephalalgias and to determine if pediatric-onset trigeminal autonomic cephalalgias display similar signs and symptoms as adult onset.

Methods

Search criteria in Medline Ovid, Embase, PsycINFO, and Cochrane Library were created by a librarian. The remainder of the steps were independently performed by two neurologists using PRISMA guidelines. Inclusion criteria for titles and abstracts were articles discussing cases of trigeminal autonomic cephalalgias with age of onset 18 or younger, as well as any epidemiological report on trigeminal autonomic cephalalgias (as age of onset data was often found in the results section but not in the title or abstract). Data extracted included age of onset, sex, and International Classification of Headache Disorders criteria for trigeminal autonomic cephalalgias (including pain location, duration, frequency, autonomic features, restlessness) and some migraine criteria (photophobia, phonophobia, and nausea). Studies that did not meet full criteria for trigeminal autonomic cephalalgias were examined separately as “atypical trigeminal autonomic cephalalgias”; secondary headaches were excluded from this category.

Results

In all, 1788 studies were searched, 86 met inclusion criteria, and most (56) examined cluster headache. In cluster headache, onset occurred at every pediatric age (range 1–18 years) with a full range of associated features. Autonomic and restlessness features were less common in pediatric patients, while migrainous features (nausea, photophobia, and phonophobia) were found at similar rates. The sex ratio of pediatric-onset cluster headache (1.8, 79 male and 43 female) may be lower than that of adult-onset cluster headache. Data for other trigeminal autonomic cephalalgias, while more limited, displayed most of the full range of official criteria. The data for atypical trigeminal autonomic cephalalgias were also limited, but the most common deviations from the official criteria were abnormal frequencies and locations of attacks.

Conclusions

Trigeminal autonomic cephalalgias can start early in life and have similar features to adult-onset trigeminal autonomic cephalalgias. Specifically, pediatric-onset cluster headache patients display the full range of each criterion for cluster headache (except maximum frequency of six instead of eight attacks per day). However, cranial autonomic features and restlessness occur at a lower rate in pediatrics. Additional information is needed for the other trigeminal autonomic cephalalgias. As for expanding the ICHD-3 criteria for pediatric-onset trigeminal autonomic cephalalgias, we have only preliminary data from atypical cases, which suggests that the frequency and location of attacks sometimes extend beyond the official criteria.

Trial Registration: This study was registered as a systematic review in PROSPERO (registration number CRD42020165256).



中文翻译:

小儿三叉神经自主神经性头痛:系统评价和荟萃分析

背景和目标

有五种头痛疾病构成三叉神经性头痛(丛集性头痛、阵发性偏头痛、伴有结膜充血和撕裂的短期单侧神经痛样头痛发作(SUNCT)、伴有颅自主神经症状(SUNA)的短期单侧神经痛样头痛发作和偏头痛)续)。在儿科人群中对这些疾病知之甚少。本研究的目的是报告儿童三叉神经自主神经性脑痛的整个年龄范围,并确定儿童三叉神经自主神经性脑痛是否表现出与成人发病相似的体征和症状。

方法

Medline Ovid、Embase、PsycINFO 和 Cochrane Library 中的搜索条件由图书管理员创建。其余步骤由两名神经科医生使用 PRISMA 指南独立执行。标题和摘要的纳入标准是讨论发病年龄在 18 岁或以下的三叉神经性脑痛病例的文章,以及关于三叉神经性脑痛的任何流行病学报告(因为发病年龄数据通常在结果部分中找到,但在标题中没有或摘要)。提取的数据包括发病年龄、性别和国际头痛疾病分类三叉神经自主神经性头痛的标准(包括疼痛部位、持续时间、频率、自主神经特征、烦躁不安)和一些偏头痛标准(畏光、畏声和恶心)。不符合三叉神经自主神经性脑痛的全部标准的研究被单独检查为“非典型三叉神经自主神经性脑痛”;继发性头痛被排除在此类别之外。

结果

总共检索了 1788 项研究,其中 86 项符合纳入标准,大多数 (56) 项检查了丛集性头痛。在丛集性头痛中,每个儿童年龄(范围 1-18 岁)都会发作,并伴有一系列相关特征。儿科患者的自主神经和躁动特征不太常见,而偏头痛特征(恶心、畏光和畏声)的发生率相似。小儿丛集性头痛的性别比例(1.8, 79 男性和 43 女性)可能低于成人丛集性头痛。其他三叉自主神经性头痛的数据虽然比较有限,但显示了大部分官方标准。非典型三叉神经自主神经性头痛的数据也很有限,但最常见的偏离官方标准的是异常的发作频率和位置。

结论

三叉神经自主神经性脑痛可以在生命早期开始,并且与成人发病的三叉神经自主神经性脑痛具有相似的特征。具体来说,儿科发作的丛集性头痛患者显示了丛集性头痛每个标准的全部范围(除了每天六次而不是八次发作的最大频率)。然而,颅内自主神经功能和躁动在儿科中的发生率较低。其他三叉神经自主神经性头痛需要更多信息。至于扩大 ICHD-3 小儿三叉神经自主神经性头痛的标准,我们只有来自非典型病例的初步数据,这表明发作的频率和位置有时会超出官方标准。

试验注册:本研究在 PROSPERO 注册为系统评价(注册号 CRD42020165256)。

更新日期:2021-08-19
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