Céphalées de l'enfant et de l'adolescent

Abstract

Headache is one of the most frequent symptoms in neuropaediatrics. Numerous types and causes of headache exist, and precise diagnosis is sometimes difficult. The primary headache (migraine and tension headache), without brain lesion are the main types. Secondary headaches are less frequent. The classification of the International Headache Society (IHS) is a good tool for the diagnosis, although it is not fully adapted for children. According to the recent epidemiologic surveys, migraines represent 90% of headaches. About 20% of migraines begin by an aura, with visual symptoms in most cases. Non habitual migraines or migraine equivalents (basilar, abdominal, confusional migraines, or migraines with prolonged aura, benign paroxystic vertigo, and visual aura without headache) are more frequent in children than in adults. Tension headaches are far less frequent in children than in adult. These different types of headache may turn to chronic daily headaches, especially in case of prolonged drug abuse. The management of patients with headache, in terms of investigations and therapy, must therefore be based on the diagnosis hypothesis that results from the neurological exam data and, above all, from the patient's questioning which allows to analyse headaches history, context and characteristics. The identification of anatomic structures and mechanisms responsible for headaches and migraines has improved these past decades, but many uncertainties remain. The availability of new drugs, such as the triptans, with a specific activity on those serotoninergic receptors which participate in the migraine process, has improved the therapeutic management of the disease.