소아 만성 매일 두통의 임상 양상과 예방 치료에 대한 반응
Clinical Characteristics and Efficacy of Prophylactic Treatment of Pediatric Chronic Daily Headache
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목 적 : 소아 및 청소년시기에서 만성매일두통을 가진 환자들의 임상양상 및 예방적 치료에 대한 반응을 알아보고자 하였다. 방 법 : 2005년 1월부터 2005년 1월부터 2011년 12월까지 분당 서울대학교병원 소아청소년과에 두통으로 진단받은 환자들 중 만성매일두통의 진단기준에 맞는 80명을 후향적으로 연구하였다. 두통의 진단기준은 2004년에 개정된 국제두통질환분류와 2006년에 제시된 기준에 따라 정의하였고 임상 양상을 바탕으로 만성 편두통, 만성 긴장형두통, 신생매일두통으로 분류하였다. 예방적 약물을 사용한 경우 두통이 있었던 날의 수가 50%이상으로 줄어든 경우, 50%이하로 줄어든 경우와 호전이 없는 경우로 나누어서 조사하였다. 결 과 : 총 80명 중 남녀비율은 1:4.3명이었고 두통이 처음 시작된 평균 나이는 11.8±1.2세였고 평균 두통 발생 빈도는 월별 25.5±4.4일이었고 지속시간은 평균 5.1±8.1시간이었다. 만성 편두통 환자가 81.2%, 만성 긴장형두통 환자가 16.2%, 신생매일두통이 5.0%, 이었다. 12.5%에서 전조증상이 있었고 두통에 동반되는 증상으로는 오심 45.0%, 구토 15.0 %, 광선 공포 38.7%, 소음 공포 21.2%, 어지러움 61.2% 이였다. 약물을 복용한 후 그 반응에 대한 조사결과에서는 예방적 약물을 시행한 경우 두통이 없어진 경우는 12.5%, 두통의 평균 월별 발병 횟수가 반 이상 줄어든 경우가 62.5% 이었다. 예방적 약물치료에 대한 부작용은 졸음, 어지러움, 체중증가, 식욕부진, 기억력 감소, 감각이상 등이 있었다. 결 론 : 소아에서의 만성매일두통에서는 만성 편두통의 환자가 가장 많았고 이들의 월별 두통 빈도가 많고 지속시간이 길다는 것을 알 수 있었다. 따라서 이러한 경우 예방요법이 꼭 필요하며 토피라메이트나 플루나지린을 사용한 약물 요법이 효과가 있는 것으로 판단된다.
Abstract
Purpose : The purpose of this study was to evaluate the clinical characteristics and efficacy of prophylactic treatment of pediatric chronic daily headache (CDH). Methods : A retrospective medical-record review of patients who underwent the prophylaxis after a diagnosis of CDH was performed. Response to treatment was assessed by the total number of headache days/month. More than 50% reduction of headache frequency was classified as responders. Results : Eighty patients with the diagnosis of CDH were included in the study. CDH was more prevalent in girls than in boys. It was classified into chronic migraine (81.2%), chronic tension-type headache (15.0%), or new-onset persistent daily headache (3.7%). None of the patient fulfilled the diagnostic criteria of hemicrania continua. The mean age of the patients was 11.8±1.2 years. The mean number of monthly headache episodes before treatment was 25.5±4.4. After prophylactic treatment, headache episodes were reduced to 8.7±9.5 episodes per month. The responder rate of prophylactic treatment was 70.2% (55/80 patients) for either topiramate or flunarizine. Conclusion : In our study, the most common type of CDH was chronic migraine. All patients with CDH had frequent, long lasting migraine attacks. This study also suggests that prophylactic treatment is effective in the treatment of pediatric CDH.
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