소아 청소년 두통에 의한 장애와 예측인자
Headache-related Disability and Predictor of Disability in Children and Adolescent
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목적:소아청소년 두통에 의한 장애를 평가하고,심한 장애를 일으킬 수 있는 예측인지를 알아보고자 하였다 . 또한 예방 치료에 따른 장애의 변화에 대하여 알아보고자 하였다 . 방법: 2010년 1월부터 2014년 12월까지 두통으로 조선대학교병원 소아신경클리닉에 방문한 환자 307명의 의무기록을 후향적으로 조사하였다 . 두통에 의한 장애를 평가하기 위해 6개의 질문으로 이루어진PedMIDAS를 사용하였으며, 장애 정도에 따라 4개의 단계로 분류하였다. 두통 형태는 국제두통질환분류법에 따라 분류하였다(ICHDII). 결과: 대상 환자 중 17%에서 두통에 의해 중등도 이상의 장애가있었다 .나이가 많을수록 장애정도가 심한 경향을 보였다 . 두통형태중에는 편두통이 가장 높은 장애점수를 보였다 .학교,놀이/레저 영역보다 집 활동에서 장애를 가장 많이 느꼈다 .두통으로 인하여 심한 장애를 예측할 수 있는 인자는 편두통인 경우,병력기간이 긴 경우 두통이 잦은 경우였다. 예방 치료에 따라 두통에 의한 장애 점수는 의미있게 감소하였다 . 결론: 많은 소아 청소년 두통 환자들에서 두통으로 인하여 학교, 집 생활, 놀이 및 레저 활동에 장애가 있었고, 나이가 많을수록, 다른두통 형태인 경우보다 편두통인 경우에 장애가 심하였다. 소아 청소년 두통 환자가 편두통인 경우와 잦은 두통이 있는 경우, 병력기간이긴 경우에는 두통에 의한 장애를 심하게 느낄 수 있기 때문에 두통에대한 조기 진단과 적절한 예방 치료를 함으로써, 두통에 대한 장애를 줄이고,소아청소년의 삶의 질을 높일 수 있을것으로 생각된다 .
Abstract
Purpose: To estimate headache-related disability and to identify predictor of disability in children and adolescent with headache. In addition, to assess the improvement of disability after treatment. Method: We conducted a retrospective analysis of clinical records of children and adolescents 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). 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 16-18year-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. The migraine patients have the worst disability. This study demonstrated that migraine, frequent headache and longer duration of symptom before presentation are the predictors of headache-related disability and a proper preventive treatment can improve the quality of life of pediatric headache patients.
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