Demographic and clinical characteristics of children and adolescents with headache and/or dizziness and hemodynamic responses to head-up tilt test.

Abstract

Background: Headache and dizziness are common symptoms in children and adolescents, but the causes of headache/dizziness in most pediatric patients are not clearly defined. We intended to investigate the demographic and clinical features of pediatric patients with headache and/or dizziness and responses to head-up tilt test (HUTT).

Methods: The demographic data and medical records of children and adolescents, with a primary complaint of headache and/or dizziness and undergoing HUTT between January 2001 and June 2023, were retrospectively reviewed and analyzed. Children and adolescents with headache and/or dizziness secondary to fever, trauma, or other obvious etiology were excluded. For those with positive responses to HUTT, the symptom score and HUTT responses were collected after treatment at follow-up.

Results: Among 2709 patients with unexplained headache and/or dizziness, 1080 (39.87%) cases presented positive responses to HUTT, whereas 1629 (60.13%) cases had negative responses. Among patients with positive responses, 930 (34.33%) cases presented a response of vasovagal syncope, 143 (5.28%) cases of postural orthostatic tachycardia syndrome, and 7 (0.26%) cases of orthostatic hypertension. Multivariate Logistic regression analysis demonstrated that females, older age, and low body mass index percentile increased the risk of being positive responses. At follow-up, HUTT results of 236 patients were collected, among which 131 (55.51%) cases turned negative HUTT responses and had headache/dizziness symptoms improved after treatment targeted autonomic dysfunction.

Conclusion: HUTT can be applied to evaluate the autonomic function of children and adolescents with headache and/or dizziness and assess the treatment responses in those patients with autonomic dysfunction.