The importance of psychological factors in pediatric recurrent headaches

Background: Headache is one of the most common health problems of children and adolescents. At least 10% of pediatric population suffer from recurrent headaches without underlying organic/structural etiologies. Social stressors such as conflicts in the family, parental divorce, death/illness of a family member, poor relationships with peers, as well as problems related to school have impact on the occurrence of nonorganic headaches. The aim: of this paper was to determine characteristics of recurrent headaches, psychological, cognitive and emotional factors that can provoke or aggravate somatic problems, and psychological characteristics of pediatric patients with episodic headaches. Material and methods: This retrospective study included children and adolescents with nonorganic recurrent headaches sent to psychological evaluation during the period from January 1, 2014 till December 31,2016. Results: The study cohort comprised 101 patients (40 males and 61 females) aged 12.24 ± 2.71 (range 7-18) years who experienced headaches at least once a week. One third lived in dysfunctional and broken families, 29% had poor relations with peers, and 20% had problems related to school. Difficulties in copying with stress were found in ¼ of patients. Conclusion: Psychological evaluation is important tool for determination psychosocial stressors and nonorganic comorbidities of migraine and tension-type headache, as well as for diagnosis of secondary headaches attributed to psychiatric disorders

Duration of valproic acid monotherapy correlates with subclinical thyroid dysfunction in children with epilepsy

Aim. To identify potential risk factors for the development of subclinical hypothyroidism following long-term valproic acid monotherapy in children with epilepsy. Methods. Serumlevels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine, thyreoglobulin antibodies, and thyroid peroxidase antibodies were determined in 41 patients and in 41 sex- And age-matched healthy children. Results. Meanvalproic acid treatment durationwas 2.80?}1.96 years. The valproic acid group had higher serum thyroid-stimulating hormone (p lt 0.001) and free triiodothyronine (p lt 0.05) levels compared to the control group. Serum thyroid-stimulating hormone and free triiodothyronine were above the upper limit for healthy controls in 34% and 32% of patients, respectively, and no clinical features of thyroid dysfunction were observed. Duration of valproic acid monotherapy for less than four years was a risk factor for elevated thyroid-stimulating hormone levels. Conclusion. One third of children with normal range serum valproic acid levels may have elevated serum thyroid-stimulating hormone and free triiodothyronine levels, especially in the first four years of treatment