Meningismus as a cause of chronic headaches in children

Chronic headaches are defined as headaches lasting for more than 15 days per month over a 3 month period.There are two common types of chronic headaches that affect children and they are tension-type and migraine headaches. Persistent headaches in children can interfere with their normal daily routines and it affects their quality of life. This can lead to considerable disruptions in their moods, sleeping patterns and the ability to function effectively at school.

Children who suffer from chronic headaches may demonstrate meningismus. Meningismus is a syndrome where the affected individual presents clinically with neurological signs and symptoms of irritation of the meninges (the protective membrane that covers the brain and spinal cord). Complaints include headaches, neck stiffness and eye discomfort due to light sensitivity.

This article will review the correlation between meningeal irritation and chronic headaches in children, and the significance of examining the signs of meningeal irritation in these patients.

Types of Chronic Primary Headaches in Children

Tension-type headaches are described as constant, squeezing pains present on both sides of the head. Possible causes may include physical and emotional stressors, eyestrain and sleep deprivation.

Migraines are recurrent, pulsatile headaches that typically affect one side of the head, and are the most frequent type of headaches in children under 6 years of age.

What Factors Trigger Meningismus-Associated Chronic Headaches in Children?

Numerous factors such as minor head injuries, lifting heavy weights and intense coughing have been linked to the development of meningismus in children. The most important factor though is the development of an infection about 1-2 months before these signs and symptoms occur.In most cases, the culprit of meningismus is the bacterium streptococcus that predominantly causes ear, nose and throat infections in children. It’s the same micro-organism that results in“strep throat” and, if left untreated, can develop into rheumatic fever in children. These children have elevated antistreptolysin-O titers (ASOT). This rise in ASOT was also observed in children with chronic headaches who demonstrated signs of meningismus.

The infection itself is not the cause of meningismus, but rather an autoimmune reaction (in which the immune system mistakenly recognizes the body’s own tissue to be foreign and starts attacking them) occurs as a complication of the streptococcal infection.

A large number of these patients also tested positive for Ebstein-Barr virus (EBV). Researchers discovered the presence of EBV in children experiencing new daily persistent headaches, therefore confirming the association between the EBV and meningismus.

What is the Mechanism of Chronic Headaches Associated with Meningismus?

The most probable mechanism behind these chronic headaches is the chronic inflammation of the outermost covering of the brain and spinal cord, the dura mater, as this is the only pain-sensitive layer of the meninges.

What is the Preferred Treatment of Children with Chronic Headaches and Meningismus?

Bed rest will help alleviate these type of headaches, together with medications designed to treat chronic headaches in children. Other preventive lifestyle measures that help include satisfactory sleep, adequate diet, eliminating triggering factors and incorporating relaxation techniques.

Summary

Meningeal irritation is proven to be the cause of chronic headaches in children. Therefore, changing the approach required for examining children presenting with chronic headaches is warranted and need to be discussed with the child’s doctor.

Author Bio: Sameer Ather MD, PhD is a Cardiologist based out of Birmingham, Alabama and is also the co-founder and CEO of website www.xpertdox.com, which is designed to help patients suffering from rare or serious diseases. His current research focus is to identify heart failure patients who do not benefit from beta-blocker.

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