Trip Answers

Question answered:20/06/07 Warning! this question is over two years old.

We found no guidelines or studies detailing the prevalence of both unilateral headache and vertigo in adolescent patients.

 

However, we did locate an epidemiological study of acute recurrent headaches in children which reported:

 

“PATIENTS AND METHODS: Information on epidemiological and clinical characteristics, physical examination and complementary examinations, if performed, was collected from the medical records of 225 children with acute recurrent headache…”

 

“RESULTS: A total of 98.2 % of the patients had primary headache: migraine (48.9 %), tension-type headache (48.4 %) and mixed (0.9 %). Thirty percent of those with migraine had migraine with aura. The mean age at onset was 8.6 6 2.9 years in migraine and 9.7 6 2.5 years in tension-type headache (p < 0.05), with no differences between sexes. Children with tension-type headache showed a greater prevalence (p < 0.05) of female sex, urban origin and excellent academic performance. Children with migraine had a greater prevalence (p < 0.05) of positive family history. Migraine headaches were unilateral (44.1 %) or bilateral (55.9 %), pulsating (77.1 %), aggravated by physical activity (68.8 %), caused lost days at school (65.3 %) and were usually accompanied by vomiting (71 %) and photophobia/sonophobia (67 %).” [1]

 

We are not in the position to give a likely diagnosis. Given we do not know how long the patient has been suffering with these symptoms, how long the symptoms last, the order in which they appear, whether both are always present, part of the brain involved i.e. temporal , occipital  etc we can only thus recommend discussing this case with a neurologist.

 

However, we did search the TRIP and Medline databases using the terms ‘unilateral headache’ and ‘vertigo’ which lead us to various articles on migraine which may be of relevance.

 

An e-Medicine article on migraine headache in children notes:

 

“Young patients with migraine (5-10 y) experience bilateral frontal, bilateral temporal, or retro-orbital headache; nausea; abdominal cramping; vomiting; photophobia; phonophobia; and a need to sleep. They usually are asleep within 1 hour of attack onset. The most common accompanying symptoms include pallor with dark circles under the eyes, tearing, swollen nasal passages, thirst, swelling, excessive sweating, increased urination, and diarrhea.
Older children tend to present with a unilateral, temporal headache. Many sinus headaches are actually of migrainous origin. The headache location and intensity often change within or between attacks.”

 

The same article describes basilar migraine:

 

“Basilar migraine (basilar artery migraine or Bickerstaff syndrome): Basilar migraine is a subtype of migraine with aura. It most commonly is observed in adolescent and young adult females. Headache pain is located in the occipital area. The occipital headache must have at least 2 of the aura symptoms listed below, which are associated with dysfunction originating from the occipital and/or brainstem area:
“Ataxia, Bilateral paresthesias, Deafness, Decreased level of consciousness, Diplopia, Dizziness, Drop attacks, Dysarthria, Fluctuating low-tone hearing loss, Tinnitus, Unilateral or bilateral vision loss, Vertigo or weakness.”

 

A second condition, benign paroxysmal vertigo of childhood is also described:

 

“Benign paroxysmal vertigo of childhood: This condition is characterized by brief episodes of vertigo, disequilibrium, and nausea. It is usually found in children aged 2-6 years. The patient may have nystagmus within, but not between, the attacks. The child does not have hearing loss, tinnitus, or loss of consciousness. Symptoms usually last only a few minutes. These children often develop a more common form of migraine as they mature. Brain MRI can be performed to exclude posterior fossa abnormalities, especially if abnormalities in the neurologic examination are found between episodes.” [2]

 

In addition, we located a study and review article on vestibular symptoms in childhood and adolescent which may also be of interest.

 

Weisleder reported dizziness and headache to be a common association in children and adolescents:

 

“…. We reviewed the charts of all children and adolescents referred for vestibular function testing to the Balance Center at the Barrow Neurological Institute between July 1994 and July 2000 (N = 31)…
The stereotypical patient with vestibular migraine was a teenage female with repeated episodes of headache and dizziness, a past history of carsickness, a family history of migraine, and a normal neurologic examination. Patients who fit this profile are likely to have migrainous vertigo…” [3]

 

Parker notes:

 

“A review of the literature gives considerable evidence that there are manifestations of migraine involving the vestibular system starting in infancy and proceeding to late life. This paper deals with these manifestations in the first two decades of life. There is evidence that vestibular symptoms are probably caused by involvement at different levels of the system in different cases. Paroxysmal vestibular symptoms may occur in association with headache, temporally independent of headache, or without headache, and may at times be the chief complaint causing the patient to seek help from the otolaryngologist in the latter two instances. Other neurologic symptoms may or may not be present. Meticulous family, past personal, and present history are the sources of information necessary to suspect the association of paroxysmal vestibular symptoms and a migraine diathesis. A prospective study of a large neurotologic population of this age group with recurrent paroxysmal vestibular symptoms seems indicated and may lead to diagnostic and therapeutic benefits.” [4]

 

For assistance in diagnosing this patient, the NLH Q & A Service would recommend seeking further advice from a neurologist.

 

References
1. Durá Travé T, Yoldi Petri ME et al.  [Acute recurrent headaches: clinical and epidemiological characteristics]. An Pediatr (Barc). 2005 Feb;62(2):141-6. (http://www.hubmed.org/display.cgi?uids=15701310)
2. Robertson W and Mack P. Migraine headache: pediatric perspective. E-Medicine. (http://www.emedicine.com/neuro/topic529.htm
3. Weisleder P and Fife TD. Dizziness and headache: a common association in children and adolescents. J Child Neurol. 2001 Oct;16(10):727-30. (http://www.hubmed.org/display.cgi?uids=11669345)
4. Parker W. Migraine and the vestibular system in childhood and adolescence. Am J Otol. 1989 Sep;10(5):364-71. (http://www.hubmed.org/display.cgi?uids=2683802).

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