Characterization of chronic daily headaches in children in a multidisciplinary headache center

What incites new daily persistent headache in children?

This study asked what incites the development of a new daily persistent headache in children. A total of 175 children with chronic daily headache were prospectively identified and observed by the author. Of these patients, 40 (23%) with a new daily persistent headache were identified. These patients had no significant prior headache history. Seventeen patients (43%) had the onset of their symptoms during an infection. Of these patients, over half had positive Epstein-Barr virus serology at the onset of symptoms. Nine patients (23%) manifested minor head injuries at the onset of their symptoms, yet had a normal examination and neuroimaging. Symptom onset was also associated with surgery (four patients) and high-altitude camping (one patient). In five patients, no specific etiologic factor could be identified. Four patients were initially identified as having idiopathic intracranial hypertension, yet their chronic headache persisted despite the normalization of their intracranial pressure. Similar findings were observed in episodic migraine patients who abruptly developed the onset of chronic migraine. In conclusion, the onset of new daily persistent headache in childhood is typically associated with a physiologic stress such as an infection, head trauma, or post-surgery.

Estrogen and chronic daily headache

Estrogen exerts a strong influence on episodic headaches, such as migraine and tension-type headache. A relationship between sex hormones and chronic daily headache (CDH) is less well established. However, similarities between episodic and CDH suggest that estrogen also may significantly influence CDH. Pathophysiologic studies of CDH identify neurochemical abnormalities similar to those influenced by estrogen in episodic headache, such as aberrant 5-hydroxytryptamine activity. In addition, gender differences in CDH prevalence in pediatric and adult populations support a hormonal influence. Few studies have evaluated the ability of gynecologic events, such as menses, to influence CDH.

Quality of life in paediatric migraine: characterization of age-related effects using PedsQL 4.0

The aim of this study was to measure quality of life (QOL) across a broad age range of paediatric migraine patients. Children and adolescents (n=686) with migraine completed the Pediatric Quality of Life Inventory, version 4.0 (PedsQL 4.0) and a standardized headache assessment at an initial clinic visit. The sample size for each PedsQL age group was: age 2-4=21, age 5-7=86, age 8-12=298, and age 13-18=281. Mean total score was 72.7 +/- 14.8, significantly less than healthy norms (P<0.01). Teens reported lower School Functioning than older and young children (P<0.05) and young children reported lower Social Functioning than older children and teens (P<0.001). A moderate relation was found between self and parent report. Age-related effects on QOL have implications for the evaluation and management of migraine in paediatric practice. The self and parent report forms of the PedsQL can be used in a practice setting.

Quality of life in childhood migraines: clinical impact and comparison to other chronic illnesses

OBJECTIVE

Despite the high prevalence of headaches in youths, quality of life (QOL) has not been well examined. We examined QOL in a clinical sample of children with headaches and compared it with children with other chronic diseases.

METHODS

A survey study was conducted of 572 consecutive patients (mean age, 11.4 +/- 3.6 years) who presented with headaches to a children's headache center. Children and parents completed the Pediatric Quality of Life Inventory, Version 4.0 and a standardized headache assessment. Results were compared with established norms for healthy and chronically ill children.

RESULTS

Most patients (99%) had a clinical diagnosis of migraine: 85% met the International Headache Society migraine criteria, and 40% had chronic daily headaches. Total Pediatric Quality of Life Inventory, Version 4.0 score was lower for the entire group (73.1 +/- 14.4) compared with healthy norms (83.0 +/- 14.8) and lowest for children with chronic daily headaches (70.5 +/- 15.5). The impact on QOL of children with migraine was similar to that of children with arthritis and cancer.

CONCLUSIONS

QOL of children with headaches is significantly affected by their health condition. The impact of headaches on QOL is similar to that found for other chronic illness conditions, with impairments in school and emotional functioning being the most prominent.

Use of the Migraine Disability Assessment Questionnaire in children and adolescents with headache: an Italian pilot study

OBJECTIVES

To determine the suitability of the Migraine Disability Assessment (MIDAS) Questionnaire for assessing disability in children and adolescents with headache and to obtain preliminary information about disability in different primary headaches.

BACKGROUND

During the last decade, researchers have begun to employ standardized methodologies to investigate the global impact of primary headaches. Disease-specific instruments have been developed to measure headache-related disability. The MIDAS Questionnaire, which is the most extensively studied of these instruments, was designed to assess the overall impact of headaches over the 3 months before compilation. The MIDAS Questionnaire is an optimal tool to assess headache-related disability in adults.

METHODS

Ninety-five patients aged 7 to 17 years with tension-type headache, migraine, or both completed the validated Italian form of the MIDAS questionnaire on 2 occasions. Test-retest reliability was assessed by the Spearman rank correlation test. The Cronbach alpha assessed internal consistency. The patients answered questions about the adequacy of the questionnaire.

RESULTS

The Cronbach alpha was.8. Correlation coefficients were generally high for the overall MIDAS score and for the items investigating disability in school and in family/leisure activities; they were lower for the items about housework. Most patients thought that the MIDAS Questionnaire was useful (98.9%) and that it captured the impact of their headaches (58.9%); 41% thought that questions about disability in housework were useless, 44.2% suggested adding questions regarding inability to do homework. All primary headaches had a considerable impact on daily activities, but patients with migraine tended to have lower headache frequencies and lower total disability time; those with tension-type headache suffered more days in which activities, although performed, were substantially impaired.

CONCLUSIONS

The MIDAS Questionnaire is useful for assessing disability in children and adolescents with different primary headaches. Minimal changes in the phrasing and content of the items would be sufficient to render the MIDAS specific for the younger population with headache.

Migraine headaches and sleep disturbances in children

OBJECTIVE

The aim of the present study was to investigate the prevalence of sleep disturbances in children with migraine headaches and to describe individual differences in sleep behaviors based on headache features (eg, frequency, duration, intensity).

BACKGROUND

A relationship between migraine headaches and sleep disturbances has been suggested in both children and adults, but there is a lack of research examining the relationship between specific headache features and the range of sleep behaviors in children.

METHODS

One hundred eighteen children, aged 2 to 12 years (mean, 9.1; standard deviation, 2.3) were evaluated for headaches at two pediatric neurology departments. Parents completed the Children's Sleep Habits Questionnaire and a standardized questionnaire regarding headache characteristics.

RESULTS

Parents reported a high rate of sleep disturbances in children, including sleeping too little (42%), bruxism (29%), child co-sleeping with parents (25%), and snoring (23%). Children with migraine headaches experienced more sleep disturbances compared to published healthy control norms. After controlling for child demographics, we found that the frequency and duration of migraine headaches predicted specific sleep disturbances, including sleep anxiety, parasomnias, and bedtime resistance.

CONCLUSIONS

Children with migraine headaches have a high prevalence of sleep disturbances. The direction of the relationship between headaches and sleep is unknown. Regardless, interventions targeting sleep habits may improve headache symptoms, and effective treatment of headaches in children may positively impact sleep.

Chronic daily headaches in children

Chronic daily headache (CDH) or highly frequent headaches are being recognised as an increasing problem. In adults it is estimated that up to 4% of the population has CDH, however, this number appears to be lower in children. The actual prevalence of CDH in children, however, has not been determined. The simplest definition of CDH is > 15 headache days per month. In the international headache society (IHS) criteria, only chronic tension-type headaches and chronic cluster headaches are recognised as CDH. Criteria for CDH have been suggested for adults that mirror the IHS criteria. In children, the majority of CDH appear to be migraine related. The next revision of the IHS criteria has been proposed to include chronic migraine as one of the CDH. Evaluation of CDH needs to include a complete history and physical examination to identify any possibility of the headache representing secondary headaches. Treatment and management involves a multi-tiered approach, which includes abortive therapy when the headache becomes more severe. With the precaution of avoiding overuse of analgesic medication, prophylactic therapy is used to help reduce the characteristics of the headache as well as the frequency and mild behavioural therapy.

Psychiatric comorbidity in chronic daily headache: pathophysiology, etiology, and diagnosis

Chronic daily headache is a challenge for clinical practitioners and researchers. Etiology, pathophysiology, diagnosis, treatment, and prognosis of chronic daily headache present many questions that need answers. A chance occurrence of psychiatric disorders (mostly anxiety and mood disorders) in patients with chronic daily headache should not be excluded. This results in the need to understand the involved mechanisms, which requires us to draw new insights into the etiology, diagnosis, treatment, and prognosis of chronic daily headache. Psychiatric comorbidity seems to be cross-related to each of these dimensions, although the meanings need to be drawn. Each domain is discussed, considering the status of knowledge and stressing the future lines of research.

Chronic daily headache in pediatric practice

Improving the quality of life of the patient presenting with chronic daily headache proves to be challenging both diagnostically and with regard to their short- and long-term management. Continued progress has been made in the classification of chronic daily headache. The extent to which an initial evaluation should be conducted to obtain a diagnosis is a paramount consideration for both the patient and the family. The introduction of disability tools targeted for this population, both in use and under evaluation, will assist in both the initial assessment and in guiding management. The chronic daily headache patient in most cases requires both a non-pharmacological and a pharmacological approach with clearly defined short- and long-term goals. The management of the expectations of both the patient and family are the key to a good outcome.