Michael M Dowling1, Michael J Noetzel2, Mark J Rodeghier3, Charles T Quinn4, Deborah G Hirtz5, Rebecca N Ichord6, Janet L Kwiatkowski6, E Steven Roach7, Fenella J Kirkham8, James F Casella9, Michael R DeBaun10. 1. Department of Pediatrics and Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX. 2. Department of Neurology, Division of Pediatric and Developmental Neurology, St Louis Children's Hospital and Washington University School of Medicine, St Louis, MO. 3. Rodeghier Consultants, Chicago, IL. 4. Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5. National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD. 6. Department of Neurology and Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA. 7. Division of Child Neurology, Ohio State College of Medicine, Columbus, OH. 8. Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom. 9. Division of Pediatric Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. 10. Department of Pediatrics Vanderbilt-Meharry-Matthew Walker Center of Excellence in Sickle Cell Disease, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: m.debaun@vanderbilt.edu.
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.
RCT Entities:
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.
Authors: T R Price; T A Manolio; R A Kronmal; S J Kittner; N C Yue; J Robbins; H Anton-Culver; D H O'Leary Journal: Stroke Date: 1997-06 Impact factor: 7.914
Authors: Shaina M Willen; Mark Rodeghier; Robert C Strunk; Leonard B Bacharier; Carol L Rosen; Fenella J Kirkham; Michael R DeBaun; Robyn T Cohen Journal: Br J Haematol Date: 2018-01-24 Impact factor: 6.998
Authors: Kristin P Guilliams; Fenella J Kirkham; Susanne Holzhauer; Steven Pavlakis; Bryan Philbrook; Catherine Amlie-Lefond; Michael J Noetzel; Nomazulu Dlamini; Mukta Sharma; Jessica L Carpenter; Christine K Fox; Marcela Torres; Rebecca N Ichord; Lori C Jordan; Michael M Dowling Journal: Stroke Date: 2019-05 Impact factor: 7.914
Authors: Andria L Ford; Dustin K Ragan; Slim Fellah; Michael M Binkley; Melanie E Fields; Kristin P Guilliams; Hongyu An; Lori C Jordan; Robert C McKinstry; Jin-Moo Lee; Michael R DeBaun Journal: Blood Date: 2018-07-30 Impact factor: 25.476