Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Çocuklarda Oksipital Bölge Baş Ağrısının Değerlendirilmesi: Tanımlayıcı Araştırma
Evaluation of Occipital Region Headache in Children: Descriptive Research
Esra SERDAROĞLUa
aGazi Üniversitesi Tıp Fakültesi, Çocuk Nörolojisi BD, Ankara, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2022;31(1):53-8
doi: 10.5336/pediatr.2022-88349
Article Language: TR
Full Text
ÖZET
 Amaç: Oksipital bölge baş ağrıları, klasik olarak ikincil baş ağrısı olarak kabul edilerek beyin görüntüleme endikayonu sayılmaktadır. Bu çalışmada, oksipital baş ağrısı olan hastaların klinik ve radyolojik özelliklerini inceleyerek, beyin görüntülemenin tanısal katkısını değerlendirmek amaçlanmıştır. Gereç ve Yöntemler: Tokat Devlet Hastanesi Çocuk Nöroloji Polikliniğine Ocak 2018-Eylül 2019 tarihleri arasında oksipital baş ağrısı şikâyeti ile başvuran hastalar retrospektif olarak değerlendirildi. Bulgular: Çocuk nöroloji polikliniğine bu süre zarfında toplam 596 hasta baş ağrısı şikâyeti ile başvurdu, 56'sında (%9,4) oksipital baş ağrısı vardı. Oksipital baş ağrısı olan hastaların 41'i (%73) kız, 15'i (%27) erkekti. Yaşları 4-17 arasında olup, ortalama 13,4±3,2 yaş olarak bulundu. Baş ağrısı ortalama 15±3,2 ay önce başlamış, hastaların 24'ünde (%43) son zamanlarda belirgin artış göstermişti. Baş ağrısı sıklığı haftada ortalama 4±3,3'tü, süresi saniyeler-saatler şeklinde değişkenlik gösteriyordu. Baş ağrısı şiddeti ortalama 7,3±1,5 olarak değerlendirildi. Oksipital ağrıya 30 (%53,5) hastada farklı bir baş bölgesinin ağrısının eşlik ettiği saptandı. Yedi (%12,5) hastada kırma kusuru, 7 (%12,5) hastada kan basıncı yüksekliği, 2 (%3,5) hastada epilepsi tanıları kondu. Beyin, manyetik rezonans görüntüleme ile milimetrik T2 hiperintensite odakları (%5), perivasküler boşluklarda genişleme (%5), belirgin sinüs inflamasyonu (%9) ve insidental bulgular (%5, 2 araknoid kist, 1 pineal kist) saptandı. Klinik yaklaşımı değiştirmeyi veya müdahale etmeyi gerektiren bir patoloji bulunmadı. Sonuç: Çocukluk ve ergenlik döneminde, oksipital bölge baş ağrısı nadir değildir. Beyin görüntüleme sadece oksipital bölgede baş ağrısı olup, nörolojik muayene bozukluğu veya başka bir alarm belirtisi olmadığında önemli bir katkı sağlamamaktadır. Hastalar kırma kusuru ve hipertansiyon gibi baş ağrısı nedenleri açısından mutlaka incelenmelidir.

Anahtar Kelimeler: Baş ağrısı; baş ağrısı bozuklukları, birincil; baş ağrısı bozuklukları, ikincil; manyetik rezonans görüntüleme
ABSTRACT
 Objective: Occipital headaches are classically considered as secondary headaches that indicate neuroimaging. This study aimed to examine the clinical and radiological features of patients with occipital headache to evaluate the diagnostic contribution of brain imaging. Material and Methods: Patients who applied to the Tokat State Hospital Pediatric Neurology Outpatient Clinic between January 2018 and September 2019 with occipital headache were evaluated retrospectively. Results: During this period, a total of 596 patients applied to the pediatric neurology outpatient clinic with headache complaints, 56 (9.4%) of them had occipital headache. Of the patients with occipital headache, 41 (73%) were female and 15 (27%) were male. Their ages were between 4-17 years, with a mean of 13.4±3.2 years. Headache started an average of 15±3.2 months ago, and had recently increased significantly in 24 (43%). The frequency of headaches was 4±3.3 per week on average, and the duration varied from seconds to hours. Headache severity was evaluated as 7.3±1.5 on average. Thirty (53.5%) patients identified accompanying pain in a different head region. Diagnoses were refractive errors in 7 (12.5%) patients, hypertension in 7 (12.5%) patients, and epilepsy in 2 (3.5%) patients. Brain magnetic resonance imaging revealed millimetric T2 hyperintensity foci (5%), enlargement of perivascular spaces (5%), significant sinus inflammation (9%), and incidental findings (5%, 2 arachnoid cysts, 1 pineal cyst). No pathology was found that required changing the clinical approach or any intervention. Conclusion: Occipital headache is not uncommon in childhood and adolescence. Brain imaging does not make a significant contribution when there is only occipital headache without neurological deficits or other alarm symptoms. Patients should be examined in terms of headache causes such as refractive errors and hypertension.

Keywords: Headache; headache disorders, primary; headache disorders, secondary; magnetic resonance imaging
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