Hakan KALEAĞASI, Aynur ÖZGE, Fevziye TOROS, HAKAN KAR

Cinsel istismar sonrası belirginleşen çocukluk çağı migren başağrısı: Olgu sunumu

Çocuklarda görülen kronik başağrılarının çoğunun idyopatik orjinli olmasına rağmen, cinsel istismar çocuklarda görülen kronik paroksismal başağrılarının nadir bir nedeni olabilir. Bu yazıda, cinsel istismar sonrasında tetiklenen ve tedaviye dirençli seyreden bir çocukluk çağı migreni olgusu sunuldu. On bir yaşında kız çocuğu iki yıldır belirginleşen başağrısı yakınmasıyla nöroloji polikliniğine başvurdu. Nörolojik muayene, görüntüleme ve laboratuvar incelemeleri normal sınırlarda bulundu. ICHD-II kriterlerine göre aurasız migren tanısı konularak profilaktik tedaviye başlandı. Tedaviye yanıt alınamaması üzerine çocuk ve ergen psikiyatrisi kliniği ile konsülte edildi ve majör depresif bozukluk tanısı aldı. Psikiyatrik görüşme takipleri sırasında olgu annesinin erkek arkadaşı tarafından iki yıldır cinsel olarak istismar edildiğini bildirdi. İtiraf ve istismarcının cezalandırılmasının ardından migren tipi başağrısının şiddeti, sıklığı ve süresi dramatik olarak azaldı. Çocukluk çağındaki fiziksel, cinsel ve emosyonel istismar prevalansı değişik serilerde %13-27 olarak bildirilmiş olup bu çocuklarda kronik ağrı, başağrısı veya depresyon ortaya çıkabilir. İlk cinsel istismara 12 yaşından önce uğrayan çocuklarda istismar ile migren-depresyon fenotipi arasındaki ilişki daha güçlüdür. Sıklıkla görülmesine rağmen, istismar birçok hekim tarafından çocukluk başağrılarında sorgulanmamaktadır. Sonuç olarak, tedaviye dirençli başağrılarında çocuk istismarı akılda tutulmalıdır. Bu olgulara adli tıp ile çocuk ve ergen psikiyatrisi klinikleriyle birlikte multidisipliner yaklaşılması ile olguların detaylı psikiyatrik değerlendirmelerinin yapılması sonuca ulaşılmasında yol gösterici ve yardımcı olacaktır.

Migraine type childhood headache aggravated by sexual abuse: Case report

Although the vast majority of chronic headache is idiopathic in origin, child abuse can be a very rare cause of paroxysmal headaches in children. The aim of this report was to present a case of migraine headache aggravated after sexual abuse, which did not respond to treatment. An 11-year-old girl admitted to the outpatient department of the Neurology Clinic with headache complaint for the past two years. Neurological examination, neuroimaging and laboratory tests were normal. According to the International Classification of Headache Disorders (ICHD)-II criteria, the headache was diagnosed as migraine without aura and treatment as prophylaxis was planned. Her headache did not respond to treatment, so she was consulted with the Department of Child and Adolescent Psychiatry and diagnosed as major depressive disorder. During one of the psychological interviews, she confessed that she had been sexually abused by her mother’s boyfriend for two years. After this confession and punishment of the abuser, her headache improved dramatically. The prevalence of physical, sexual, and emotional abuse during childhood has been estimated between 13% and 27%, and these children may suffer chronic pain, headache or depression. Sexual abuse has been strongly associated with the migraine-depression phenotype when abuse first occurred before the age of 12 years. Despite the high prevalence of abuse, many physicians do not routinely ask about abuse history. In conclusion, child abuse must be kept in mind in intractable childhood headache. A multidisciplinary approach with the Departments of Forensic Sciences and Child and Adolescent Psychiatry and detailed psychiatric evaluation should be useful in these cases.

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