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Headache and migraine in children with sickle cell disease are associated with lower hemoglobin and higher pain event rates but not silent cerebral infarction

Headache and migraine in children with sickle cell disease are associated with lower hemoglobin and higher pain event rates but not silent cerebral infarction
Headache and migraine in children with sickle cell disease are associated with lower hemoglobin and higher pain event rates but not silent cerebral infarction

OBJECTIVE: To identify risk factors for headache and migraine in children with sickle cell disease and test the hypothesis that either or both are independently associated with silent cerebral infarcts.

STUDY DESIGN: In this cross-sectional study, we evaluated the health history, laboratory values, and brain magnetic resonance imaging findings of participants with sickle cell disease (hemoglobinSS or hemoglobinSβ°-thalassemia) with no history of overt stroke or seizures. Participants characterized headache severity and quality. Migraine was defined by International Headache Society criteria modified for increased sensitivity in children. Neuroradiology and neurology committees adjudicated the presence of silent cerebral infarction by review of magnetic resonance imaging and standardized examination by pediatric neurologists.

RESULTS: The cohort included 872 children (51.1% males), ranging in age from 5 to 15 years (mean age, 9.1 years). Of these children, 317 (36.4%) reported recurrent headaches, and 132 (15.1%) reported migraines. In multivariable logistic regression analyses, both were associated with lower steady-state hemoglobin (P = .01 for headaches; P < .01 for migraines) and higher pain rate (P < .01 for headaches; P < .01 for migraines), defined as the number of admissions requiring opioids in the previous 3 years. The presence of silent cerebral infarction was not associated with recurrent headaches or migraines. Only 1.9% (6 of 317) of children with recurrent headaches received medication for headache prophylaxis.

CONCLUSION: Recurrent headaches and migraines are common and undertreated in children with sickle cell disease. Low hemoglobin levels and high pain rates are associated with recurrent headaches and migraines; whereas, silent cerebral infarction is not.

Adolescent, Anemia, Sickle Cell, Biomarkers, Blood Transfusion, Cerebral Infarction, Child, Child, Preschool, Cross-Sectional Studies, Female, Headache, Hemoglobins, Humans, Logistic Models, Magnetic Resonance Imaging, Male, Migraine Disorders, Multivariate Analysis, Pain, Recurrence, Risk Factors, Severity of Illness Index, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't
0022-3476
1175-1180.e1
Dowling, Michael M.
55720e49-d317-44bd-9cc6-8cc840232fe3
Noetzel, Michael J.
f6698ae3-df53-47e4-be74-cadd701dcefe
Rodeghier, Mark J.
f1141bb4-70fb-4ff1-b12a-fb58e7bd8864
Quinn, Charles T.
0d87d8ee-be4d-4b45-a2bd-5431b6f6df31
Hirtz, Deborah G.
bfd7ae1c-b247-40ca-a5cb-30abe7c9eee5
Ichord, Rebecca N.
d3cb64eb-0dab-4e05-bbb6-f0ff9bbdcea8
Kwiatkowski, Janet L.
1b8490e1-f6a7-4f80-9ee4-ad3c4c4e9ecb
Roach, E. Steven
d0c60042-c7b0-4c25-bd86-445ef03f0eae
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Casella, James F.
9dc1e151-e300-4f4f-9488-133e1eac1d6e
DeBaun, Michael R.
76559153-80c6-4642-bdf8-672a75570dfe
Dowling, Michael M.
55720e49-d317-44bd-9cc6-8cc840232fe3
Noetzel, Michael J.
f6698ae3-df53-47e4-be74-cadd701dcefe
Rodeghier, Mark J.
f1141bb4-70fb-4ff1-b12a-fb58e7bd8864
Quinn, Charles T.
0d87d8ee-be4d-4b45-a2bd-5431b6f6df31
Hirtz, Deborah G.
bfd7ae1c-b247-40ca-a5cb-30abe7c9eee5
Ichord, Rebecca N.
d3cb64eb-0dab-4e05-bbb6-f0ff9bbdcea8
Kwiatkowski, Janet L.
1b8490e1-f6a7-4f80-9ee4-ad3c4c4e9ecb
Roach, E. Steven
d0c60042-c7b0-4c25-bd86-445ef03f0eae
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Casella, James F.
9dc1e151-e300-4f4f-9488-133e1eac1d6e
DeBaun, Michael R.
76559153-80c6-4642-bdf8-672a75570dfe

Dowling, Michael M., Noetzel, Michael J., Rodeghier, Mark J., Quinn, Charles T., Hirtz, Deborah G., Ichord, Rebecca N., Kwiatkowski, Janet L., Roach, E. Steven, Kirkham, Fenella J., Casella, James F. and DeBaun, Michael R. (2014) Headache and migraine in children with sickle cell disease are associated with lower hemoglobin and higher pain event rates but not silent cerebral infarction. Journal of Pediatrics, 164 (5), 1175-1180.e1. (doi:10.1016/j.jpeds.2014.01.001).

Record type: Article

Abstract

OBJECTIVE: To identify risk factors for headache and migraine in children with sickle cell disease and test the hypothesis that either or both are independently associated with silent cerebral infarcts.

STUDY DESIGN: In this cross-sectional study, we evaluated the health history, laboratory values, and brain magnetic resonance imaging findings of participants with sickle cell disease (hemoglobinSS or hemoglobinSβ°-thalassemia) with no history of overt stroke or seizures. Participants characterized headache severity and quality. Migraine was defined by International Headache Society criteria modified for increased sensitivity in children. Neuroradiology and neurology committees adjudicated the presence of silent cerebral infarction by review of magnetic resonance imaging and standardized examination by pediatric neurologists.

RESULTS: The cohort included 872 children (51.1% males), ranging in age from 5 to 15 years (mean age, 9.1 years). Of these children, 317 (36.4%) reported recurrent headaches, and 132 (15.1%) reported migraines. In multivariable logistic regression analyses, both were associated with lower steady-state hemoglobin (P = .01 for headaches; P < .01 for migraines) and higher pain rate (P < .01 for headaches; P < .01 for migraines), defined as the number of admissions requiring opioids in the previous 3 years. The presence of silent cerebral infarction was not associated with recurrent headaches or migraines. Only 1.9% (6 of 317) of children with recurrent headaches received medication for headache prophylaxis.

CONCLUSION: Recurrent headaches and migraines are common and undertreated in children with sickle cell disease. Low hemoglobin levels and high pain rates are associated with recurrent headaches and migraines; whereas, silent cerebral infarction is not.

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More information

e-pub ahead of print date: 13 February 2014
Published date: May 2014
Additional Information: Copyright © 2014 Elsevier Inc. All rights reserved.
Keywords: Adolescent, Anemia, Sickle Cell, Biomarkers, Blood Transfusion, Cerebral Infarction, Child, Child, Preschool, Cross-Sectional Studies, Female, Headache, Hemoglobins, Humans, Logistic Models, Magnetic Resonance Imaging, Male, Migraine Disorders, Multivariate Analysis, Pain, Recurrence, Risk Factors, Severity of Illness Index, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't

Identifiers

Local EPrints ID: 420595
URI: https://eprints.soton.ac.uk/id/eprint/420595
ISSN: 0022-3476
PURE UUID: 9831cfc2-82f5-4583-b23a-682a3616be49
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

Catalogue record

Date deposited: 10 May 2018 16:30
Last modified: 12 Nov 2019 01:51

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Contributors

Author: Michael M. Dowling
Author: Michael J. Noetzel
Author: Mark J. Rodeghier
Author: Charles T. Quinn
Author: Deborah G. Hirtz
Author: Rebecca N. Ichord
Author: Janet L. Kwiatkowski
Author: E. Steven Roach
Author: Fenella J. Kirkham ORCID iD
Author: James F. Casella
Author: Michael R. DeBaun

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