만성 두통 환아의 진단적 접근에 있어 어지럼증의 임상적 의의에 대한 연구
A Study of Clinical Significance of Dizziness in Diagnostic Approach for Children with Chronic Headache
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Purpose : Headache is a common neurologic symptom in children but chronic headache in them must be diagnosed in different ways. The aim of this study is to determine the algorithm of diagnostic approach for children with chronic headache and know the clinical significance of dizziness in evaluating those children. Methods : We recruited children with headache at Myongji Hospital from January 2004 to July 2006. The study was based on a retrospective review of their medical records and interviews with the children and their parents. We divided them into two groups : Group A headache with dizziness, Group B headache without dizziness. Results : The medical records of 86 children and adolescents with headache were reviewed. Age for group A ranged from 10 to 15 years(73.7%) and gender ratio was 1:1.7. Age for group B ranged mostly under 7 years(56.3%) and gender ratio was 1:0.85. Headache in group A frequently occurred predominantly in the morning(37.3%). The duration of the attack was over 90 min(87.5%) in group A and over 90 min(50.0%) in group B. Associated symptoms were mainly nausea(34.2%), vomiting(18.4%), blurred vision(12.7%) in group A. Over 90% of them had headache 4 times a week and so did dizziness. The final diagnoses in cases of group A were migraine(31.6%), orthostatic hypotension(15.8%), postural orthostatic tachycardia syndrome(13.2%), and benign paroxysmal positional vertigo(10.5%). While in group B diagnoses included sinusitis(50.0%), migraine(31.3%), and complications of migraine(8.3%). Conclusion : This study revealed high percentage of headache concurred with dizziness in children. The association of headache with dizziness is complex and maybe coincidental. If chronic headache with dizziness in girls occurs mainly in the morning, it maybe related to vestibular disorder and orthostatic instability. In conclusion, dizziness and other associated symptoms or clinical features should carefully be assessed in the diagnosis of headache.
Abstract
Purpose : Headache is a common neurologic symptom in children but chronic headache in them must be diagnosed in different ways. The aim of this study is to determine the algorithm of diagnostic approach for children with chronic headache and know the clinical significance of dizziness in evaluating those children. Methods : We recruited children with headache at Myongji Hospital from January 2004 to July 2006. The study was based on a retrospective review of their medical records and interviews with the children and their parents. We divided them into two groups : Group A headache with dizziness, Group B headache without dizziness. Results : The medical records of 86 children and adolescents with headache were reviewed. Age for group A ranged from 10 to 15 years(73.7%) and gender ratio was 1:1.7. Age for group B ranged mostly under 7 years(56.3%) and gender ratio was 1:0.85. Headache in group A frequently occurred predominantly in the morning(37.3%). The duration of the attack was over 90 min(87.5%) in group A and over 90 min(50.0%) in group B. Associated symptoms were mainly nausea(34.2%), vomiting(18.4%), blurred vision(12.7%) in group A. Over 90% of them had headache 4 times a week and so did dizziness. The final diagnoses in cases of group A were migraine(31.6%), orthostatic hypotension(15.8%), postural orthostatic tachycardia syndrome(13.2%), and benign paroxysmal positional vertigo(10.5%). While in group B diagnoses included sinusitis(50.0%), migraine(31.3%), and complications of migraine(8.3%). Conclusion : This study revealed high percentage of headache concurred with dizziness in children. The association of headache with dizziness is complex and maybe coincidental. If chronic headache with dizziness in girls occurs mainly in the morning, it maybe related to vestibular disorder and orthostatic instability. In conclusion, dizziness and other associated symptoms or clinical features should carefully be assessed in the diagnosis of headache.
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