The epidemiology of headache among children with brain tumor

Summary

In this report we present aspects of the epidemiology of headache (i.e., pain in the head, face, ear, or neck) among children with brain tumors. The data are derived from the 3,291 subjects in the Childhood Brain Tumor Consortium databank. Overall, 62% of the children with brain tumors experienced chronic or frequent headaches prior to their first hospitalization: 58% of children with supratentorial tumors and 70% of children with infratentorial tumors. The relative frequency of headache increased through age 7 and then leveled off regardless of tumor location. For children under age 5, headache rarely had a duration of more than 1 year prior to hospitalization. Among children over age 4, headache duration of at least one year was significantly greater for supratentorial than for infratentorial tumors. Children with a brain tumor and headache had a different distribution of symptoms and neurologic signs than those without headache. Tumor location and headache status were interactively associated with the presence of other symptoms and neurologic signs. Children with headache had a greater number of other symptoms and neurologic signs. Regardless of tumor location among children with headache, nausea or vomiting, papilledema, and hypoactive tendon reflexes were more frequent, while upper extremity weakness, optic atrophy, and irritability were less frequent. Diplopia, coma, stiff neck, anesthesia or hypesthesia, pupillary abnormalities, and abnormalities of personality, academic performance, or speech were associated with headache in children with supratentorial tumors. No specific symptoms or neurologic signs were associated with headache in children with infratentorial tumors. Supratentorial craniopharyngioma, ependymoma, and protoplasmic astrocytoma were associated with significantly high rates of headache as was infratentorial pilocytic astrocytoma.

INSTITUTIONS Barnes and St. Louis Children's Hospital, St. Louis William F. Blank, Keith H. Fulling Cardinal Glennon Memorial Hospital, St. Louis John D. Blair, Daphne DeMello Children's Hospital, Boston Floyd H. Gilles, Ana Sotrel Children's Hospital of Denver Edmund N. Orsini, Jr. Children's Hospital of Los Angeles Hart Isaacs Children's Hospital of Philadelphia Lucy B. Rorke Children's Hospital of Pittsburgh Yoshie Hashida, Robert A. Price, Eduardo J. Yunis, Barbara W. Zaias Hospital for Sick Children, Toronto Eduardo J. Yunis, Barbara W. Zaias Larry E. Becker Los Angeles County-University of Richard L. Davis Southern California Medical Center St. Christopher's Hospital for Children, Philadelphia Guillermo A. de Leon, Dale Huff, Gladys Mestre, Masoud Shamszadeh SLIDE READERS Lester S. Adelman Tufts University Medical School R. Damon Averill, Jr. University of Michigan Medical School Richard L. Davis University of California, San Francisco Umberto DeGirolami University of Massachusetts Medical School Harvard Medical School E. Tessa Hedley-Whyte Harvard Medical School Hannah C. Kinney Harvard Medical School George M. Kleinman Yale Medical School, University of Connecticut Medical School James H. Morris Harvard Medical School E.P. Richardson, Jr. Harvard Medical School Lucy B. Rorke University of Pennsylvania Medical School William C. Schoene Harvard Medical School Thomas W. Smith University of Massachusetts Medical School Raymond A. Sobel Harvard Medical School ADMINISTRATIVE/ DATA COLLECTION STAFF Carol Kenney, Donna Morelli EDITORIAL/DATA ANALYSIS COMMITTEE Floyd H. Gilles, E. Tessa Hedley-Whyte, Alan Leviton, Eugene Sobel, C. Jane Tavare