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HEADACHE: A PROBLEM-ORIENTED APPROACH IN PEDIATRICS
Khafizova Zemfira Barievna
Associate Professor of the Department of Pediatrics for the
Faculty of Medicine, ASMI
Abstract:
The article describes the main causes of headaches in children and adolescents. It
covers the issues of treating headaches in childhood, in particular the importance of non-steroidal
anti-inflammatory drugs. The central place in this is occupied by ibuprofen.
Kеywоrds:
Pediatrics, method, treatment.
INTRОDUСTIОN
Headache (cephalgia) is any unpleasant sensation that occurs in the head area from the eyebrows
to the back of the head. This is one of the most common complaints in medicine, which can be
associated with a wide variety of diseases and is the main symptom of more than 50 diseases.
The prevalence of cephalgia increases with age, reaching 80% by the age of 15, but even 2-3-
year-old children can have “migraine equivalents,” including episodes of vomiting. Considering
that headache significantly reduces a person’s quality of life, its early pathogenetic and
differential diagnosis, and rational treatment are urgent tasks in the practice of a pediatrician and
family doctor [1].
MАTЕRIАLS АND MЕTHОDS
Pain is always colored by emotional experiences, which gives it an individual character. At the
same time, headaches vary in intensity, localization, it can be shooting, pressing, pulsating,
cutting, constant or periodic, it can be bilaterally symmetrical, predominate on one side or be
exclusively one-sided. The division of pain into acute and chronic is especially important. The
sources of headache are areas of the dura mater, arteries of the base of the brain and intracranial
arteries, tissues covering the skull, trigeminal, glossopharyngeal, vagus cranial nerves, as well as
the first and second cervical spinal roots. Headache is divided into primary (migraine, tension
pain, cluster pain) and secondary (with cranial, otolaryngological, dental and other problems), it
can be caused by intracranial and extracranial causes. Particularly relevant in pediatric practice
are the so-called common causes of headaches in acute respiratory infections, fever of various
origins, hypoxia, hypercapnia, arterial hypertension, allergies, anemia, etc [2].
RЕSULTS АND DISСUSSIОN
Cephalgia may occur as a result of injuries, various intracranial processes (meningitis,
encephalitis, abscess, stroke, hematoma, thrombosis, embolism, hemorrhage, tumor, etc.), with
occlusive hydrocephalus, cranial neuralgia (trigeminal, lingual, auriculotemporal, nasociliary,
glossopharyngeal, occipital and other nerves), infections (meningitis, encephalitis, osteomyelitis
of the skull bones, various extracerebral infectious diseases), with systemic diseases of
connective tissue (arteritis), cardiovascular diseases (arterial hypertension, etc.), metabolic,
endocrine (hypoglycemia, etc.), ophthalmological, otolaryngological (otitis, sinusitis, etc.),
dental problems, intoxications (lead, etc.), after lumbar puncture, with abuse of certain
medications, damage to the temporomandibular joint, etc.
A group of headaches not associated with structural lesions is distinguished: pain from external
pressure (prolonged irritation of the superficial nerves of the scalp when wearing tight, tightly
squeezing hats, headbands, goggles for swimmers), when exposed to cold stimuli (cold weather,
strong wind, swimming, diving in cold water, cold food, water with ice, ice cream - ice-cream
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headache), against the background of coughing attacks, etc [3].
The International Headache Society distinguishes the following cephalgias: migraine, tension
pain, cluster headache, chronic paroxysmal hemicrania, pain not associated with structural brain
damage, pain due to head trauma, vascular diseases, intracranial nonvascular diseases, substance
use or withdrawal, extracerebral infections, metabolic disorders, due to pathology of the skull,
neck, eyes, ears, nose, paranasal sinuses, teeth, mouth, and other facial or cranial structures,
cranial neuralgia, pain due to pathology of nerve trunks, unclassified headache. All these types of
cephalgia can be observed in children, but tension pain and migraine are more common.
Tension headache accounts for 90% of all types of headache. It is defined as a headache that
occurs in response to mental strain, which is the result of acute or chronic stress. Mental strain is
accompanied by increased tone of the frontal, temporal, occipital, trapezius muscles, which
spasm the vessels located in them, leading to ischemia and edema and increasing pain. The
duration of the headache is from 30 minutes to 7 days. The headache can be constricting,
squeezing, squeezing, monotonous, "helmet" or "hard hat" type, diffuse, bilateral, weak or
moderate intensity. This pain does not exclude everyday activity, although the quality of study or
work deteriorates, and with everyday physical activity the headache does not intensify. Nausea,
anorexia, photo- and phonophobia at the height of the headache may occur [4].
Although tension headaches are most often caused by psychosocial stress, they can also be
associated with prolonged muscle tension in antiphysiological positions (the so-called school
headaches). Vertebrogenic causes are of great importance in the genesis of pain. Provoking
factors can be a change in the weather, forced fasting, working in a stuffy room, physical and
mental overstrain. Migraine, as a rule, begins in adolescence and young age, but can begin even
at 2-3 years of age. It has a complex pathogenesis. The presence of genetically determined
limbic-stem dysfunction and impaired metabolism of serotonin and tyramine is assumed. In the
first phase of migraine development, vasospasm is noted in the pool of the external or internal
carotid artery, there is an excessive release of serotonin from platelets, as well as norepinephrine
as a derivative of tyramine. Subsequently, the second phase occurs - vasodilation, substance P,
calcitonin, histamine are released, stimulating further expansion of blood vessels and increasing
the permeability of the vascular wall, which leads to perivascular edema, neurogenic
inflammation (third phase). The fourth phase is the reverse development of the process.
СОNСLUSIОN
Thus, headaches are one of the most common complaints with which patients seek medical
attention, and they are relevant for children and adolescents. When treating a patient with
cephalgia in pediatrics, there should be a multidisciplinary approach; in therapy, it is important to
take into account the underlying disease and modern approaches to pain pharmacotherapy,
among which the central place belongs to ibuprofen.
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