Headache in Children and Adolescents by Ishaq Abu-Arafeh & Aynur Özge

Author:Ishaq Abu-Arafeh & Aynur Özge
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

19.2 Case Discussion

19.2.1 Analysis of Headache Characteristics and Classification

According to classification of ICHD-3 beta, her headache type did not fulfill the criteria of any type of primary headache disorders and the presence of bilateral papilledema clearly indicated a secondary cause of headache [1]. Bilateral papilledema associated with a recent onset headache suggested intracranial hypertension (IH). In order to decide whether this IH is primary or secondary and to exclude any vascular or space occupying lesion, cranial MRI and MRI venography were performed and were shown to be within normal limits.

After excluding the risk of cerebral herniation with normal neuroradiological findings, lumbar puncture was performed. Hatice’s opening cerebrospinal fluid (CSF) pressure was 430 mm water, and CSF biochemical and microscopic examination was otherwise normal. The raised intracranial pressure without any clinical and radiological evidence of space occupying or vascular lesion suggests the diagnosis of idiopathic intracranial hypertension.

In order to confirm the diagnosis of IIH, other possible causes of secondary intracranial hypertension such as viral infection, endocrine disorders (e.g., hypoparathyroidism), vitamin A and D deficiencies, Turner syndrome, drug use (such as corticosteroids, tetracycline, or nalidixic acid), head trauma, systemic lupus erythematosus, Behçet’s disease, and galactosemia were excluded on reviewing the clinical history and examination and also by appropriate genetic, biochemical, microbiological, and other investigations [2]. Venous sinus thrombosis had already been excluded via MR venography, and intracranial infections were excluded by the normal CSF protein and glucose with no bacterial growth. Some frequently observed cranial MRI findings of IIH such as posterior globe flattening, optic nerve sheath distension, decreased pituitary gland size, and horizontal tortuosity of the optic nerve were not present in this case.

The criteria for the diagnosis of headache due to IIH are given in Table 19.1 [1]. The exact mechanism of IIH is not known, [3] and females are predominantly affected in a ratio of 9:1 in adults, but to a lesser degree in children. Obesity in woman of child-bearing age is also a known risk factor. Headache is a common feature of IIH observed in 68–98 % of affected children and adults. However, atypical cases of IIH may present without headache in 5–15 % of cases. Some patients with IIH may present with headache, but without papilledema. Allodynia which is commonly reported in primary headaches, especially migraine, may also be present in IIH. Visual complications are less common in children than adults, and this patient did not show any visual field defect or cranial nerve paralysis, though she had a widening of central scotoma during visual field studies.Table 19.1Criteria for the diagnosis of headache due to IIH [1]

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