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Nilles C, Williams JV, Patten SB, Pringsheim TM, Orr SL. Lifestyle Factors Associated With Frequent Recurrent Headaches in Children and Adolescents: A Canadian Population-Based Study. Neurology 2024; 102:e209160. [PMID: 38417103 DOI: 10.1212/wnl.0000000000209160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/07/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Lifestyle behaviors have been postulated to affect headache frequency in youth and are often the primary target of self-management recommendations. Our study aimed to assess the association between various lifestyle factors and frequent recurrent headaches in children and youth. METHODS Children and adolescents aged 5-17 years were enrolled in a large cross-sectional Canadian population-based health survey, completed on January 31, 2019. Headache frequency was dichotomized into "approximately once/week or less" or ">once/week" (defined as frequent recurrent headaches). The association between frequent headaches and meal schedules, screen exposure, physical activity, chronotype, and frequent substance use/exposure (alcohol, cigarettes, electronic cigarettes, and cannabis) was assessed using both unadjusted logistic regression models and models adjusted for age/sex. Fully adjusted models examined the odds of frequent headaches according to all exposures. Survey design effects were accounted for using bootstrap replicate weighting. RESULTS There were an estimated nweighted = 4,978,370 eligible participants in the population. The mean age was 10.9 years (95% CI 10.9-11.0); 48.8% were female; 6.1% had frequent headaches. Frequent headaches were associated with older age (odds ratio [OR] = 1.31, 95% CI 1.28-1.34, p < 0.001) and female sex (OR = 2.39, 95% CI 2.08-2.75, p < 0.001). In models adjusted for age/sex, the odds of frequent headaches decreased with meal regularity (adjusted OR [aOR] = 0.90, 95% CI 0.89-0.92, p < 0.001) and increased with later chronotype (aOR = 1.10, 95% CI 1.05-1.15, p < 0.001) and excess screen exposure (≥21 hours vs none in past week: aOR = 2.97, 95% CI 1.53-5.77, p = 0.001); there was no significant association with reported physical activity (aOR = 0.95, 95% CI 0.67-1.34, p = 0.77). In 12- to 17-year-olds, frequent headaches were associated with frequent alcohol use (≥1/wk vs never: aOR = 3.50, 95% CI 2.18-5.62, p < 0.001), binge drinking (≥5 times in past month vs never: aOR = 5.52, 95% CI 2.95-10.32, p < 0.001), smoking cigarettes (daily vs never: aOR = 3.81, 95% CI 1.91-7.62, p < 0.001), using e-cigarettes (daily vs never: aOR = 3.10, 95% CI 2.29-4.20, p < 0.001), and cannabis use (daily vs never: aOR = 3.59, 95% CI 2.0-6.45, p < 0.001). In the entire sample, daily exposure to smoking inside the house was associated with frequent headaches (aOR = 2.00, 95% CI 1.23-3.27, p = 0.005). DISCUSSION Several lifestyle behaviors were associated with frequent headaches in children and youth, such as meal irregularity, late chronotype, prolonged screen exposure, and frequent substance use/exposure, suggesting that these are potential modifiable risk factors to target in this population.
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Affiliation(s)
- Christelle Nilles
- From the Department of Clinical Neurosciences (C.N., S.B.P., T.M.P.), Psychiatry, Pediatrics and Community Health Sciences; Department of Community Health Sciences (J.V.W.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.B.P., T.M.P., S.L.O.); Hotchkiss Brain Institute (T.M.P., S.L.O.); Department of Clinical Neurosciences (T.M.P., S.L.O.); and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jeanne V Williams
- From the Department of Clinical Neurosciences (C.N., S.B.P., T.M.P.), Psychiatry, Pediatrics and Community Health Sciences; Department of Community Health Sciences (J.V.W.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.B.P., T.M.P., S.L.O.); Hotchkiss Brain Institute (T.M.P., S.L.O.); Department of Clinical Neurosciences (T.M.P., S.L.O.); and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Scott B Patten
- From the Department of Clinical Neurosciences (C.N., S.B.P., T.M.P.), Psychiatry, Pediatrics and Community Health Sciences; Department of Community Health Sciences (J.V.W.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.B.P., T.M.P., S.L.O.); Hotchkiss Brain Institute (T.M.P., S.L.O.); Department of Clinical Neurosciences (T.M.P., S.L.O.); and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Tamara M Pringsheim
- From the Department of Clinical Neurosciences (C.N., S.B.P., T.M.P.), Psychiatry, Pediatrics and Community Health Sciences; Department of Community Health Sciences (J.V.W.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.B.P., T.M.P., S.L.O.); Hotchkiss Brain Institute (T.M.P., S.L.O.); Department of Clinical Neurosciences (T.M.P., S.L.O.); and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Serena L Orr
- From the Department of Clinical Neurosciences (C.N., S.B.P., T.M.P.), Psychiatry, Pediatrics and Community Health Sciences; Department of Community Health Sciences (J.V.W.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.B.P., T.M.P., S.L.O.); Hotchkiss Brain Institute (T.M.P., S.L.O.); Department of Clinical Neurosciences (T.M.P., S.L.O.); and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
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Almuslim N, Alnajjar A, Alkhteeb N, Alhussain M, Alrubaia H, Alkhateeb A. Examining the Impact of Puberty on Primary Headache Disorders in Female Schoolchildren: A Cross-Sectional Study. Cureus 2023; 15:e49871. [PMID: 38170047 PMCID: PMC10760788 DOI: 10.7759/cureus.49871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction and aim Headaches are one of the most prevalent childhood disorders. Primary and secondary headaches are the two types of headaches affecting kids and teenagers. The three most typical primary headache forms are tension-type headaches (TTH), migraine, and cluster headaches. This study sought to determine the relationship between puberty and types of headaches. Methods This cross-sectional study was conducted from May 18 to July 31, among female schoolchildren aged between eight and 15 years in the Eastern Province of Saudi Arabia. Respondents were recruited through face-to-face interviews. A self-administered questionnaire was utilized, mainly consisting of demographic data and questions related to diagnosing and managing the impact of puberty in girls on the prevalence of primary headache disorder. Results In total, 481 female schoolchildren were interviewed, mostly between 13 and 15 years old (65.9%). Last year prevalence of headaches was 65.5%, with a significant difference among those who lived in Dhahran (p=0.001) and those with a family history of headaches (p<0.001). The most common type of headache was frequent TTH (16.4%) and chronic TTH (16%). Chronic TTH (p<0.001), frequent TTH (p<0.001), and migraine without aura (p=0.005) were significantly more common among the older age groups. Conclusion There was a high prevalence of headaches among female schoolchildren, with frequent TTH and chronic TTH being the most common. Furthermore, increasing age was associated with an increasing risk for chronic TTH, frequent TTH, and migraine headaches without aura. More epidemiological studies are necessary to determine the underlying causes of headaches among schoolchildren.
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Karaaslan Z, Uygunoğlu U, Şaşmaz T, Uludüz D, Topaloğlu P, Siva A, Yapıcı Z. The Prevalence of Headache Disorders in Children and Adolescents in Istanbul: A School-Based Study. Pediatr Neurol 2023; 149:100-107. [PMID: 37837756 DOI: 10.1016/j.pediatrneurol.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/14/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Headache among children and adolescents is an important health problem. In this school-based epidemiological study conducted in Istanbul, we aimed to reveal the frequency of headaches in this population, define the risk factors associated with headaches, and establish the effect of headaches on the quality of life in this population. METHODS The child and adolescent versions of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation structured questionnaire were conducted in 30 schools in Istanbul. The diagnosis was made based on the International Classification of Headache Disorders III-(ICHD-3) beta version. Risk factors associated with headaches were analyzed in a binary logistic regression model. RESULTS Among the 5944 students (boys = 3011 [50.7%], girls 2933 [49.3%]) who completed the survey and were enrolled in this study, 3354 (56.4%) reported a headache ever. The prevalence of headaches was significantly higher in girls (62.6% vs. 50.4%, P < 0.001). Migraine prevalence was found to be 5.2%, whereas tension-type headache (TTH) prevalence was 26.1%. Being a female, age, living on the European side, and headache history in the family were found to be associated with an increased risk of having a headache. Pupils with headaches reported that they missed an average of 0.5 ± 1.5 school days due to headaches. CONCLUSION TTH was found to be the most common headache syndrome in Istanbul metropolitan area. Considering the effect of headaches on school success and quality of life in childhood, it is clear that the correct diagnosis of headaches and careful handling of risk factors are crucial for this population.
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Affiliation(s)
- Zerrin Karaaslan
- Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey; Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Uğur Uygunoğlu
- Cerrahpaş a Faculty of Medicine, Department of Neurology, Istanbul-Cerrahpaş a University, Istanbul, Turkey
| | - Tayyar Şaşmaz
- Faculty of Medicine, Department of Public Health, Mersin University, Mersin, Turkey
| | - Derya Uludüz
- Cerrahpaş a Faculty of Medicine, Department of Neurology, Istanbul-Cerrahpaş a University, Istanbul, Turkey
| | - Pınar Topaloğlu
- Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Aksel Siva
- Cerrahpaş a Faculty of Medicine, Department of Neurology, Istanbul-Cerrahpaş a University, Istanbul, Turkey
| | - Zuhal Yapıcı
- Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey.
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Nilles C, Williams JVA, Patten S, Pringsheim T, Orr SL. Association Between Peer Victimization, Gender Diversity, Mental Health, and Recurrent Headaches in Adolescents: A Canadian Population-Based Study. Neurology 2023; 101:e1654-e1664. [PMID: 37532511 PMCID: PMC10624480 DOI: 10.1212/wnl.0000000000207738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/20/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It is unknown whether bullying and gender diversity are associated with increased headache frequency in adolescents. Our study aimed to assess the association between peer victimization, gender diversity, and frequent recurrent headaches in adolescents, while controlling for age, sex, socioeconomic status, and potential confounders (mood and anxiety disorders, suicidality). METHODS This was a cross-sectional observational study of adolescents aged 12-17 years using data from a Canadian population-based health survey. Headache frequency was dichotomized into "≤once/wk" or ">once/wk" (i.e., frequent recurrent headaches). Logistic regression was used to quantify the association between frequent peer victimization (overt or relational), gender diversity (female sex at birth + male gender, male sex at birth + female gender, or gender diverse), mood/anxiety disorder, suicidality, and the odds of frequent recurrent headaches. The fully adjusted multivariable logistic regression model included all exposures and was controlled for age, sex, and socioeconomic status. Bootstrap replicate weighting was used to account for survey design effects. RESULTS There were an estimated 2,268,840 eligible participants (weighted sample size) (mean age = 14.4 years, 48.8% female, 0.5% gender diverse), and 11.2% reported frequent recurrent headaches. Frequent recurrent headaches were associated with older age (odds ratio [OR] = 1.26 per year of age, 95% CI 1.20-1.31), female sex (OR = 2.89, 95% CI 2.47-3.37), and being gender diverse (OR = 3.30, 95% CI 1.64-6.63, adjusted for age/sex). Youth with frequent headaches had higher odds of experiencing both overt and relational bullying compared with peers (OR = 2.69, 95% CI 2.31-3.14, and OR = 3.03, 95% CI 2.58-3.54, adjusted for age/sex). In the fully adjusted model, frequent headaches were no longer associated with gender diversity (OR = 1.53, 95% CI 0.63-3.69) but were still associated with frequent overt and relational peer victimization (OR = 1.82, 95% CI 1.41-2.34, and OR = 1.54, 95% CI 1.17-2.03, respectively), suicidality (OR = 1.83, 95% CI 1.44-2.32), and having a mood or anxiety disorder (OR = 1.50, 95% CI 1.01-2.21, and OR = 1.74, 95% CI 1.24-2.45, respectively). In a model adjusted for age, sex, and mood/anxiety disorders, the risk of suicidality increased incrementally with headache frequency. DISCUSSION Peer victimization and suicidality may be associated with higher headache frequency in adolescents with headaches, independently of mood and anxiety symptoms. Gender-diverse adolescents may have a higher risk of experiencing frequent headaches when compared with cisgender peers, and this may be explained by associated psychosocial factors (anxiety, depression, suicidality, and peer victimization).
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Affiliation(s)
- Christelle Nilles
- From the Department of Clinical Neurosciences (C.N., S.P., T.P.), Psychiatry, Pediatrics and Community Health Sciences, University of Calgary; Departments of Community Health Sciences (J.V.A.W.) and Clinical Neurosciences (T.P., S.L.O.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.P., T.P., S.L.O.); Hotchkiss Brain Institute (T.P., S.L.O.), University of Calgary; and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jeanne V A Williams
- From the Department of Clinical Neurosciences (C.N., S.P., T.P.), Psychiatry, Pediatrics and Community Health Sciences, University of Calgary; Departments of Community Health Sciences (J.V.A.W.) and Clinical Neurosciences (T.P., S.L.O.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.P., T.P., S.L.O.); Hotchkiss Brain Institute (T.P., S.L.O.), University of Calgary; and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Scott Patten
- From the Department of Clinical Neurosciences (C.N., S.P., T.P.), Psychiatry, Pediatrics and Community Health Sciences, University of Calgary; Departments of Community Health Sciences (J.V.A.W.) and Clinical Neurosciences (T.P., S.L.O.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.P., T.P., S.L.O.); Hotchkiss Brain Institute (T.P., S.L.O.), University of Calgary; and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Tamara Pringsheim
- From the Department of Clinical Neurosciences (C.N., S.P., T.P.), Psychiatry, Pediatrics and Community Health Sciences, University of Calgary; Departments of Community Health Sciences (J.V.A.W.) and Clinical Neurosciences (T.P., S.L.O.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.P., T.P., S.L.O.); Hotchkiss Brain Institute (T.P., S.L.O.), University of Calgary; and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Serena L Orr
- From the Department of Clinical Neurosciences (C.N., S.P., T.P.), Psychiatry, Pediatrics and Community Health Sciences, University of Calgary; Departments of Community Health Sciences (J.V.A.W.) and Clinical Neurosciences (T.P., S.L.O.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.P., T.P., S.L.O.); Hotchkiss Brain Institute (T.P., S.L.O.), University of Calgary; and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
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Togha M, Jafari E, Salami Z, Kamali K, Mirzaee Godarzee H, Mirzaee Godarzee M, Bavarnegin S. The prevalence and impact of tension-type headache in school-aged children in Iran. Front Neurol 2023; 14:1259624. [PMID: 37780714 PMCID: PMC10538125 DOI: 10.3389/fneur.2023.1259624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Background Tension-Type Headache (TTH) is regarded as the third most prevalent disorder worldwide, prompting children to seek medical attention. Our objective is to investigate the prevalence of TTH among students aged 6 to 18 years in various geographical regions of Iran, while also assessing the impact of headaches on their quality of life. Methods Employing a cross-sectional survey, we have carefully distributed self-completed structured questionnaires to students in 121 meticulously selected schools throughout the country, ensuring the representation of its diverse population. Results Among the 2,958 potential participants, we have included a total of 2031 individuals in our study. This comprises 57.3% children and 42.7% adolescents, with 50.02% being males and 49.97% females. Specifically, we have examined 950 subjects with TTH and 1,081 individuals without any form of headache. TTH was diagnosed in 32.1% of the participants. Notably, we have observed a significant difference in the average age between the TTH subjects and those without headaches. Participants without headaches were more likely to be enrolled in primary schools, while those diagnosed with TTH predominantly attended high schools. We found no significant relationship between urban-rural areas or different geographic regions and the prevalence of TTH or its subtypes. Phonophobia was commonly associated with TTHs. Lastly, the mean quality-of-life score was highest for individuals without headaches, followed by those with low frequency episodic TTH, high frequency episodic TTH, and chronic TTHs. There was also a significant relation between headache severity and quality of life scores. Conclusion The significant prevalence of TTH in children and adolescents and its adverse impact on the daily activities of individuals underscore the utmost importance of accurate diagnosis and efficient management.
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Affiliation(s)
- Mansoureh Togha
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Jafari
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zhale Salami
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Molecular Genetics, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Koorosh Kamali
- School of Public Health, Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Mohadeseh Mirzaee Godarzee
- Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sanaz Bavarnegin
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Khurana P, Gupta M, Gupta N, Bansal RK, Jain V. Retrospective Observational Study Amidst Myriad Conundrums and Myths of Pediatric Headaches: A Critique on Diagnostics and Effectiveness of Interventions. Cureus 2023; 15:e42424. [PMID: 37637669 PMCID: PMC10448782 DOI: 10.7759/cureus.42424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To study the etiological profile of pediatric headaches (PH) in a tertiary child neurology clinic and to determine the utility of diagnostics, interventions, and long-term prognosis. Methods Children (ages 4-15) observed over four years were recruited retrospectively. In primary headaches, the headache frequency and impact on quality of life (QOL) parameters at pre-treatment (T1) were compared post-treatment at follow-up (T2). Results Of the 311 eligible patients, 285 had primary headaches (Tension-Type Headache {TTH}: 156; Migraine: 129), and 26 had secondary headaches. The mean (±SD) onset age was 10 (±3) years with a male-to-female ratio of 2.3:1. Migraine was more common in children aged less than seven years (17/28) and TTH in older patients (146/283). The most common causes of secondary headache were intracranial hypertension (ICH) in 11/26 patients (four idiopathic intracranial hypertension (IIH), four following aseptic meningitis, three with cortical vein thrombosis), and ophthalmologic causes in 7/26 (of these five had convergence insufficiency). Hypertension was a rare cause of secondary headaches (2/26 patients). Neuroimaging was performed in 173/311 (56%), primarily for parental anxiety (160/173; 92%), and was abnormal in only four. At T2 (Median time to follow-up: 29 months; Interquartile range: 22-37 months), data were collected in 207/285 patients with primary headaches (TTH: 109; Migraine: 98). In both migraine and TTH groups, there were statistically significant reductions (p-value <0.0001) in headache frequency and QOL parameters. Conclusion In our study, TTH was the most common cause of PH. Neuroimaging was normal in most cases. Psychological interventions were effective but underutilized. The symptoms of primary headaches improved significantly over time, despite poor adherence to prophylactic medications.
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Affiliation(s)
| | - Mayank Gupta
- Psychiatry and Behavioral Sciences, Southwood Psychiatric Hospital, Pittsburgh, USA
| | - Nihit Gupta
- Psychiatry, Dayton Children's Hospital, Dayton, USA
| | | | - Vivek Jain
- Pediatric Neurology, Neo Clinic Children's Hospital, Jaipur, IND
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Moyes C, Belaghi R, Webster RJ, Whitley N, Pohl D. Cognitive Behavioral Therapy for Children With Headaches: Will an App Do the Trick? J Child Neurol 2023; 38:169-177. [PMID: 37097885 DOI: 10.1177/08830738231170067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Participants were enrolled into a pilot randomized-controlled 4-week trial comparing the efficacy and feasibility of app-based cognitive behavioral therapy (CBT) to a stretching program. Headache-related disability and quality of life were assessed using the Pediatric Migraine Disability Scale (PedMIDAS), Kidscree27, and Pediatric Quality of Life Inventory. Multivariable regression analysis were performed to assess the group effects in the presence of adherence and other covariates. Twenty participants completed the study. Adherence was significantly higher in the stretching than in the CBT app group (100% vs 54%, P < .034). When controlling for adherence and baseline scores, the stretching group showed greater reduction in PedMIDAS score (average: 29.2, P < .05) as compared to the CBT app group. However, in terms of the Quality-of-Life Indicators, pre- and postintervention raw scores were not significantly different between groups (P > .05). App-based CBT was not superior to a stretching program in reducing headache-related disability in a select population of pediatric headache patients. Future studies should assess if implementing features to the CBT app, like tailoring to pediatric age groups, would improve outcomes.
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Affiliation(s)
- Carinna Moyes
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Reza Belaghi
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Richard J Webster
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Nicole Whitley
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Daniela Pohl
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Safiri S, Kolahi AA, Noori M, Nejadghaderi SA, Aslani A, Sullman MJM, Farhoudi M, Araj-Khodaei M, Collins GS, Kaufman JS, Gharagozli K. Burden of tension-type headache in the Middle East and North Africa region, 1990-2019. J Headache Pain 2022; 23:77. [PMID: 35794530 PMCID: PMC9258079 DOI: 10.1186/s10194-022-01445-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/24/2022] [Indexed: 01/03/2023] Open
Abstract
Abstract
Introduction
Tension-type headache (TTH) is the most prevalent neurological disorder. As there is a gap in the literature regarding the disease burden attributable to TTH in the Middle East and North Africa (MENA) region, the aim of the present study was to report the epidemiological indicators of TTH in MENA, from 1990 to 2019, by sex, age and socio-demographic index (SDI).
Methods
Publicly available data on the point prevalence, annual incidence and years lived with disability (YLDs) were retrieved from the global burden of disease (GBD) 2019 study for the 21 countries and territories in MENA, between 1990 and 2019. The results were presented with numbers and age-standardised rates per 100000 population, along with their corresponding 95% uncertainty intervals (UIs).
Results
In 2019, the age-standardised point prevalence and annual incidence rates for TTH in the MENA region were 24504.5 and 8680.1 per 100000, respectively, which represents a 2.0% and a 0.9% increase over 1990-2019, respectively. The age-standardised YLD rate of TTH in this region in 2019 was estimated to be 68.1 per 100000 population, which has increased 1.0% since 1990. Iran [29640.4] had the highest age-standardised point prevalence rate for TTH, while Turkey [21726.3] had the lowest. In 2019, the regional point prevalence of TTH was highest in the 35-39 and 70-74 age groups, for males and females, respectively. Furthermore, the number of prevalent cases was estimated to be highest in those aged 35-39 and 25-29 years, in both males and females, respectively. Moreover, the burden of TTH was not observed to have a clear association with SDI.
Conclusions
While the prevalence of TTH in the MENA region increased from 1990 to 2019, the incidence rate did not change. In addition, the burden of TTH in MENA was higher than at the global level for both sexes and all age groups. Therefore, prevention of TTH would help alleviate the attributable burden imposed on the hundreds of millions of people suffering from TTH around the region.
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Abu-Arafeh I, Valeriani M, Prabhakar P. Headache in Children and Adolescents: A Focus on Uncommon Headache Disorders. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2287-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Jia G, Wang X, Lv H, Nonyane MSC, Hou H, Ma L, Shan P, Wu X. The efficacy and safety of antiepileptics in the prophylaxis of pediatric migraine: the meta-analysis of randomized controlled trials. Transl Pediatr 2021; 10:1779-1791. [PMID: 34430426 PMCID: PMC8349954 DOI: 10.21037/tp-20-478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migraine is the most common primary headache among children and adolescents. The aim of this meta-analysis was to evaluate the efficacy and safety of antiepileptic drugs in the prevention of pediatric migraine. METHODS PubMed, Cochrane Library, EMBASE and Chinese National Knowledge Infrastructure (CNKI) databases were searched for eligible published RCTs from January 1970 to June 2020. Migraine frequency and ≥50% response rate were measured as the efficacy outcomes. We used "Risk of Bias" tool for quality assessment and RevMan5.3 software for statistical analysis. RESULTS Four articles containing 7 RCTs with 794 participants compared the efficacy of AEDs with placebo. Four RCTs assessed topiramate vs. placebo and 3 RCTs evaluated divalproex sodium extended-release (DVPX ER) vs. placebo. The results demonstrated that children receiving antiepileptic drugs had a significant advantage in remitting the mean monthly migraine days compared to those who received placebo, with an MD of -0.48 (n=930, 95% CI: -0.84 to -0.12, Z=2.60, P=0.009). Topiramate significantly reduced monthly migraine days (MD =-0.70, n=489, 95% CI: -1.16 to -0.25, Z=3.01, P=0.003) but failed to improve the ≥50% response rate (MD =-1.50, n=489, 95% CI: 0.70 to 3.22, Z=1.05, P=0.30). DVPX ER did not significantly reduce monthly headache frequency (n=441, 95% CI: -0.70 to 0.47, Z=0.38, P=0.70) or improve the ≥50% response rate (n=441, 95% CI: 0.59 to 1.25, Z=0.82, P=0.41) compared with placebo. Topiramate and DVPX ER were related to higher rates of side effects and adverse reactions. DISCUSSION Topiramate can reduce monthly headache days in children and adolescents with migraine. However, it failed to improve the ≥50% response rate. DVPX ER showed no difference from placebo in the prophylactic treatment pediatric migraine. Side effects seemed to be more frequent in topiramate and DVPX ER treated children but generally well-tolerated.
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Affiliation(s)
- Guoyong Jia
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xingbang Wang
- Department of Geriatrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hongbo Lv
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | | | - Haiguang Hou
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Lin Ma
- Department of Geriatrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Peiyan Shan
- Department of Geriatrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xinwei Wu
- Department of Geriatrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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11
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Genizi J, Bugdnoskya V, Aboud A, Segal I, Assaf N, Srugo I, Kerem NC. Migraine and Tension-Type Headache Among Children and Adolescents: Application of International Headache Society Criteria in a Clinical Setting. J Child Neurol 2021; 36:618-624. [PMID: 33507829 DOI: 10.1177/0883073820988417] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The International Headache Society criteria were written in order to help physicians establish a headache diagnosis. However, sometimes children with headache do not seem to fit any diagnosis. The purpose of our study was to assess the application of the criteria in a clinical setting. METHODS Medical records of children referred for primary headache to the pediatric neurology clinic at Bnai Zion Medical Center from 2008 to 2017 were assessed. RESULTS A total of 989 patients (range 6-18 years; 53% female) were assessed at our neurology clinic. Twenty-four percent (n = 241) were diagnosed with tension-type headache, 26% (n = 256) with migraine, and 4.5% (45) with mixed headache. In 41.5% (410), we were unable to reach a specific diagnosis. No differences in gender or age were found between the groups. Children in the migraine group used more analgesic treatments to stop the headache attacks compared with the tension-type headache group (50% vs 38%, P = .001). Patients diagnosed with tension-type headache reported having more emotional difficulties (P = .001). No significant differences were found in headache characteristics (ie, location, sidedness, character), frequency, or intensity between the younger children (ages 6-11) and the adolescents (ages 12-18) within either the tension-type headache or migraine groups. CONCLUSIONS Retrospective application of International Headache Society criteria in a large cohort of children with headaches failed to diagnose a specific type of headache in 41.5% of children. Migraine and tension-type headache were equally prevalent, and both constituted a major burden on our patients' everyday lives. We found no major differences in frequency, intensity, and characteristics of pain between younger children and adolescents.
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Affiliation(s)
- Jacob Genizi
- Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel.,Pediatric Department, Bnai Zion Medical Center, Haifa, Israel.,Bruce Rappaport Faulty of Medicine, Technion, Haifa, Israel
| | - Vera Bugdnoskya
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Amer Aboud
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Idan Segal
- Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel.,Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Nurit Assaf
- Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Isaac Srugo
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel.,Bruce Rappaport Faulty of Medicine, Technion, Haifa, Israel
| | - Nogah C Kerem
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel.,Adolescent Medicine Unit, Bnai Zion Medical Center, Haifa, Israel.,Bruce Rappaport Faulty of Medicine, Technion, Haifa, Israel
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12
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Khatatbeh AE, Othman EF, Alalawneh AM, Albdour MQ, Jaradat TF, Al Hazaimeh AM, Ahmed M, Abbas K. Ocular and Dental Causes of Headaches Among School-Age Children in Jordan: A Retrospective Study. Cureus 2021; 13:e15623. [PMID: 34277240 PMCID: PMC8277091 DOI: 10.7759/cureus.15623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Headache disorders are becoming increasingly prevalent among the younger population. In this study, we aimed to explore the varying causes of headaches among school-age children in Jordan. Methodology This was a retrospective observational study conducted at the Queen Rania Hospital for Children between June 2019 and June 2020. All the data of the patients were extracted from the patient files with the permission of the administration. All children who were referred to the ophthalmology and dental clinic with headaches as the presenting complaint were included in the study. A detailed history was initially obtained regarding age, gender, medical history, as well as the duration and characteristics of headaches. The patients underwent detailed ocular examination including best-corrected visual acuity (BCVA) using the Snellen chart, anterior and posterior eye segment examination, and intraocular pressure measurement. Refraction under the effect of cyclopentolate was performed for all patients. A detailed dental and oral exam was performed on all children at the dental clinic by the same dentist. Results A total of 712 patients aged between five and 13 years (mean ± SD: 9.3 ± 2.86 years) presented with headaches during the study period. Headaches were more frequent in males [n=441 (61.9%)], but a slight female predominance was found among patients aged 11 years and older. At the ophthalmology clinic, 230 (32.3%) patients with headaches had positive findings; the majority of these patients [n=228 (32%)] had refractive errors with astigmatism as the most common type. Of note, 515 patients (72.3%) had dental caries with a Decayed, Missing, and Filled Permanent Teeth (DMFT) score ranging from 1.5 to 4.3. Conclusion Refractive errors, particularly astigmatism, were found at higher rates among children with headaches. Also, temporomandibular disorders were more prevalent among children with headaches, particularly those aged between 11 and 14 years. Routine ophthalmic and dental assessment is recommended for children presenting with chronic headaches.
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Affiliation(s)
| | | | | | | | | | | | - Moiz Ahmed
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK.,Medicine and Surgery, Sindh Medical College, Karachi, PAK
| | - Kiran Abbas
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
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13
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Scaling Approaches for Pediatric Dose Selection: The Fremanezumab (AJOVY ®) Journey to Select a Phase 3 Dose Using Pharmacokinetic Data from a Phase 1 Study. Pharmaceutics 2021; 13:pharmaceutics13060785. [PMID: 34074002 PMCID: PMC8225049 DOI: 10.3390/pharmaceutics13060785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022] Open
Abstract
Fremanezumab, a fully humanized IgG2Δa/kappa monoclonal antibody, selectively targets the calcitonin-gene-related peptide (CGRP) and prevents it from binding to the CGRP receptor. The safety, tolerability, pharmacokinetics (PK), and efficacy of fremanezumab for treating migraines administered as a once monthly 225 mg dose or a once quarterly 675 mg dose have been well characterized in adults. The fremanezumab exposure and body weight relationship supported the use of the approved 225 mg monthly adult dose for pediatric patients weighing ≥45 kg. In the pediatric Phase 3 program, a 120 mg dose for patients weighing <45 kg was determined using the results of an open-label study and a population PK modeling and simulation strategy. A thorough evaluation was conducted to further characterize the population PK of fremanezumab and assess the predictive performance of the adult population PK model when applied to the Phase 1 pediatric data, the predictive performance of alternative pediatric population PK models, and the predictive performance of the selected pediatric population PK model via a noncompartmental-based approach. This latter comparison to noncompartmental results provided additional evidence that the pediatric population PK model predicts the observed data well and supports the 120 mg monthly dose in patients weighing <45 kg.
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14
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Shuaibi S, AlAshqar A, Ahmed SF, Alroughani R, AlThufairi H, Owayed S, AlHamdan F, Al-Hashel J. Primary Headache Disorder Among School Students in Kuwait. Front Neurol 2021; 12:621017. [PMID: 33603711 PMCID: PMC7884619 DOI: 10.3389/fneur.2021.621017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Primary headaches are remarkably prevalent worldwide and are increasingly reported among children. However, the exact trend in this age group, particularly in the Gulf region, remains largely unknown. Aims and Objectives: To examine the prevalence of primary headache disorders among primary and middle school students in Kuwait. Methods: We conducted a cross-sectional study that included Kuwaiti primary and middle school children and adolescents of both genders in randomly selected schools located in two governorates in Kuwait in the 2018/2019 academic year. Prevalence and attributable burden of headaches, definite and probable migraines, definite and probable tension-type headaches, chronic headaches (≥15 days/month), and probable medication-overuse headaches were assessed using the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire for children and adolescents. Results: Of 1,485 questionnaires that were distributed, 1,089 students completed the questionnaire with a respondent rate of 73.4%. The study population consisted of 420 boys (38.56%) and 669 girls (61.43%) students with a mean age of 11.5 ± 2.11 years. The 1-year prevalence of primary headache disorders was 42.78%, with more middle schoolers reporting headaches than primary schoolers (50.37 vs. 30.48%; p < 0.02). The mean age of students with primary headaches was 11.98 ± 2.03 years in both genders. When stratified according to diagnostic criteria, migraine headaches were the most frequently reported (20.75%), followed by tension type headaches (18.8%), chronic headaches (2.75%), and probable medication-overuse headaches (0.46%). Primary headaches were significantly higher in girls compared to boys among middle schoolers (66.46 vs. 38.49%; p < 0.001); however, no significant difference between genders was noted among primary school students (33.12 vs. 22.33%; p < 0.118). Conclusion: Primary headaches are remarkably common in Kuwaiti school students, with migraine headaches being the most frequently reported type. Age and female gender may play a role in the development of primary headaches. These findings necessitate the direction of health services and research efforts toward this age group and warrant the need for further epidemiological studies.
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Affiliation(s)
- Sameera Shuaibi
- Internal Medicine Department, Ministry of Health, Kuwait, Kuwait
| | | | - Samar Farouk Ahmed
- Neurology Department, Ibn Sina Hospital, Safat, Kuwait
- Neuropsychiatry Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | | | - Shaikhah Owayed
- Internal Medicine Department, Ministry of Health, Kuwait, Kuwait
| | | | - Jasem Al-Hashel
- Neurology Department, Ibn Sina Hospital, Safat, Kuwait
- Faculty of Medicine, Kuwait University, Safat, Kuwait
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15
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Severity of Chronic Pain in German Adolescent School Students. Clin J Pain 2020; 37:118-125. [DOI: 10.1097/ajp.0000000000000898] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/26/2020] [Indexed: 02/02/2023]
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16
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Yamanaka G, Go S, Morichi S, Takeshita M, Morishita N, Suzuki S, Tomoko T, Kasuga A, Daida A, Ishida Y, Oana S, Suganami Y, Nagao R, Kashiwagi Y, Kawashima H. Clinical Features and Burden Scores in Japanese Pediatric Migraines With Brainstem Aura, Hemiplegic Migraine, and Retinal Migraine. J Child Neurol 2020; 35:667-673. [PMID: 32476572 DOI: 10.1177/0883073820927840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Migraines are a broad spectrum of disorders classified by the type of aura with some requiring attentive treatment. Vasoconstrictors, including triptans, should be avoided in the acute phase of migraines with brainstem aura, in hemiplegic migraine, and in retinal migraine. This study investigated the characteristics and burden of these migraines. METHODS Medical charts of 278 Japanese pediatric patients with migraines were retrospectively reviewed. Migraine burden of migraines with brainstem aura, hemiplegic migraines, and retinal migraine was assessed using the Headache Impact Test-6™ (HIT-6) and the Pediatric Migraine Disability Assessment scale (PedMIDAS). RESULTS Of 278 patients screened, 12 (4.3%) patients with migraines with brainstem aura (n = 5), hemiplegic migraines (n = 2), and retinal migraine (n = 5) were enrolled in the study. All patients had migraine with/without typical aura, whereas some patients had coexisting migraine with another type of headache (chronic tension-type headache in 3 patients, and 1 each with frequent episodic tension-type headache, headache owing to medication overuse, and chronic migraine). Migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients with coexisting headaches had higher HIT-6 or PedMIDAS scores, whereas migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients without coexisting headache did not show high HIT-6 or PedMIDAS scores. CONCLUSION All migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients experienced migraine with or without typical aura, and some patients having other coexisting headaches also had high PedMIDAS and HIT-6 scores. PedMIDAS and HIT-6 should not be considered diagnostic indicators of migraines with brainstem aura, hemiplegic migraines, or retinal migraine. In clinical practice for headaches in children, careful history taking and proactive assessment of the aura are needed for accurate diagnosis of migraines with brainstem aura, hemiplegic migraines, and retinal migraine.
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Affiliation(s)
- Gaku Yamanaka
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Soken Go
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shinichiro Morichi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Mika Takeshita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Natsumi Morishita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shinji Suzuki
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Takamatsu Tomoko
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Akiko Kasuga
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Atsuro Daida
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yu Ishida
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shingo Oana
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yusuke Suganami
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Ryuhei Nagao
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yasuyo Kashiwagi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Hisashi Kawashima
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
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17
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Alashqar A, Shuaibi S, Ahmed SF, AlThufairi H, Owayed S, AlHamdan F, Alroughani R, Al-Hashel JY. Impact of Puberty in Girls on Prevalence of Primary Headache Disorder Among Female Schoolchildren in Kuwait. Front Neurol 2020; 11:594. [PMID: 32765391 PMCID: PMC7379333 DOI: 10.3389/fneur.2020.00594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/22/2020] [Indexed: 01/10/2023] Open
Abstract
Background: The prevalence of primary headaches in the pediatric population is shaped by many factors, of which pubertal status may possibly play a substantial role. Epidemiological studies in the pediatric population in the gulf region remain scarce. Aims and objectives: To examine the impact of puberty on the prevalence of primary headache disorders among female schoolchildren in Kuwait. Methods: We conducted a cross-sectional study that included Kuwaiti primary and middle schoolgirls in randomly selected schools located in two governorates in Kuwait during the academic year 2018/2019. Prevalence of headache was assessed using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents. Female students were asked about their menarchal status and whether they attained menarche before or after experiencing headaches. Results: The questionnaire was completed by 669 girls with a mean age of 11.44 ± 2.14 years. The 1-year prevalence of migraine headache disorder among girls was 23.62%, and the lifetime prevalence of any headache was 84.9%, whereas the 1-year prevalence of primary headache disorders was 47.98%. The mean age of girls with headaches was 11.44 ± 2.14 years. With respect to diagnostic criteria, migraine headache was the most frequently reported (23.62%), followed by tension-type headaches (20.93%), chronic headaches (2.99%), and probable medication-overuse headaches (0.45%). Postpubertal females were at significantly higher risk of having primary headaches compared to their prepubertal counterparts (64.26 vs. 34%; p < 0.0001). All types of primary headaches were more significantly prevalent among postpubertal girls compared to those who are prepubertal. Conclusion: Migraine headache is commonly reported among Kuwaiti schoolgirls. Postpubertal females are at higher risk of developing primary headaches compared to prepubertal females. Pubertal transition and female sex hormones may play a significant role in the pathophysiology of headaches, migraines in particular, and further research is therefore needed to investigate the underlying mechanisms.
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Affiliation(s)
| | - Sameera Shuaibi
- Internal Medicine Department, Ministry of Health, Kuwait City, Kuwait
| | - Samar Farouk Ahmed
- Neurology Department, Ibn Sina Hospital, Safat, Kuwait.,Neuropsychiatry Department, Faculty of Medicine, Al-Minia University, Minia, Egypt
| | - Hawraa AlThufairi
- Obstetrics and Gynecology Department, Ministry of Health, Kuwait City, Kuwait
| | - Shaikhah Owayed
- Obstetrics and Gynecology Department, Ministry of Health, Kuwait City, Kuwait
| | | | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Jasem Yousef Al-Hashel
- Neurology Department, Ibn Sina Hospital, Safat, Kuwait.,Faculty of Medicine, Kuwait University, Safat, Kuwait
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18
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Valade D. Cefalee tensive. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)43685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Wu X, Zhang Y, Lu M, Yu X, Ye X, Wang X, Shan P. The Efficacy and Safety of Topiramate in the Prevention of Pediatric Migraine: An Update Meta-Analysis. Front Pediatr 2020; 8:28. [PMID: 32175291 PMCID: PMC7056737 DOI: 10.3389/fped.2020.00028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/20/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Migraine is the most common acute primary headache in children and adolescents. In 2014, topiramate became the first preventive drug for migraine, approved by the Food and Drug Administration (FDA) for adolescents. This meta-analysis was aimed to evaluate the efficacy and safety of topiramate in the prevention of pediatric migraine. Methods: We searched the PubMed, EMBASE, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI) databases up to June 2019 for eligible randomized controlled trials (RCTs). The primary outcomes were mean migraine days per month, ≥50% reduction rate, and Pediatric Migraine Disability Assessment Scale (PedMIDAS) scores. RevMan5.3 software was performed for statistical analysis. Results: Overall, 5 RCTs recruiting 531 patients (6-17 years of age) were included in the meta-analysis. The target dose of topiramate was 2 mg/kg (the maintenance phase was 12 weeks), 2-3 mg/kg, 50 mg/day, and 100 mg/day (maintaining for 16 weeks), respectively, in the included studies. Our results demonstrate that participants receiving topiramate had a significant advantage in remitting the monthly migraine days than those receiving placebo, with a mean difference (MD) of -0.78 (n = 531; 95% CI, -1.23 to -0.32; Z = 3.37; P = 0.0008). Topiramate could also reduce the mean PedMIDAS scores (n = 238; 95% CI, -16.53 to -0.49; Z = 2.43; P = 0.04). However, there was no significant difference in the percentage of patients experiencing a ≥50% reduction in monthly headache days between topiramate and placebo groups (n = 531; 95% CI, 0.94-1.77; Z = 1.58; P = 0.11). Topiramate was associated with higher rates of side effects such as weight decrease (n = 395; 95% CI, 2.73-22.98; Z = 3.81; P < 0.01) and paresthesia (n = 531; 95% CI, 3.05-13.18; Z = 4.94; P < 0.01). Conclusions: Topiramate can significantly decrease monthly headache days and migraine-related burden in migraine patients <18 years old. However, it failed to increase 50% response rate. Adverse events seem to be more frequent in topiramate-treated children.
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Affiliation(s)
- Xinwei Wu
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Yan Zhang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Mei Lu
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaolin Yu
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Xiang Ye
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Xingbang Wang
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Peiyan Shan
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
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20
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Paredes S, Cantillo S, Candido KD, Knezevic NN. An Association of Serotonin with Pain Disorders and Its Modulation by Estrogens. Int J Mol Sci 2019; 20:E5729. [PMID: 31731606 PMCID: PMC6888666 DOI: 10.3390/ijms20225729] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
Ovarian hormones play an important role in pain perception, and are responsible, at least in part, for the pain threshold differences between the sexes. Modulation of pain and its perception are mediated by neurochemical changes in several pathways, affecting both the central and peripheral nervous systems. One of the most studied neurotransmitters related to pain disorders is serotonin. Estrogen can modify serotonin synthesis and metabolism, promoting a general increase in its tonic effects. Studies evaluating the relationship between serotonin and disorders such as irritable bowel syndrome, fibromyalgia, migraine, and other types of headache suggest a clear impact of this neurotransmitter, thereby increasing the interest in serotonin as a possible future therapeutic target. This literature review describes the importance of substances such as serotonin and ovarian hormones in pain perception and illustrates the relationship between those two, and their direct influence on the presentation of the aforementioned pain-related conditions. Additionally, we review the pathways and receptors implicated in each disorder. Finally, the objective was to stimulate future pharmacological research to experimentally evaluate the potential of serotonin modulators and ovarian hormones as therapeutic agents to regulate pain in specific subpopulations.
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Affiliation(s)
- Stephania Paredes
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
| | - Santiago Cantillo
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
| | - Kenneth D. Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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21
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Ertem DH, Bingol A, Ugurcan B, Mercan Ö, Simsek I, Sağlam H, Ozge A, Uluduz D. The impact of parental attitudes toward children with primary headaches. Clin Child Psychol Psychiatry 2019; 24:767-775. [PMID: 30895815 DOI: 10.1177/1359104519838571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
There is a lack of data on parental attitudes toward children with primary headaches. The aim of this study is to determine whether there is a relationship between primary headaches and parental attitudes in the pre-adolescent pediatric population. In this cross-sectional study, 195 children with primary headache and 43 healthy children aged 9-16 years were included. A questionnaire for sociodemographic variables, visual analog scale (VAS), Social Anxiety Scale and Depression Inventory for Adolescents and Children, and Parental Attitudes Determining Scale (PATS), which is an attitude measure specifically designed to evaluate psychological adjustment, were administered. Of 195 children (female/male ratio: 89/106, mean age: 12.59 ± 1.09 years), episodic migraine (n = 90), chronic migraine (n = 25), and tension-type headache (n = 80) were evaluated. There was no significant difference among headache groups and healthy subjects in terms of depression, anxiety, and fathers' attitude scale scores. However, there were significant differences in mean mothers' attitude scale scores and VAS scores (p = .002, p = .000). Mean oppressive-authoritarian attitude subscale scores of mothers' was significantly higher in children with chronic migraine (p = .000). A relationship between depression and VAS scores among all patient groups was detected (p = .000). Parental age was negatively related to PATS scores of children with episodic migraine and tension-type headache (p = .037 and p = .036). Parental attitudes may elevate psychiatric symptoms and influence children's perception of pain intensity and result in chronification of headache. Our findings support that mothers' attitude toward children with chronic migraine has strong impacts on the child's pain experience.
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Affiliation(s)
- Devrimsel Harika Ertem
- Department of Neurology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Turkey
| | - Ayhan Bingol
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Busra Ugurcan
- Department of Guidance and Counseling, Bahçeşehir University, Turkey
| | - Özlem Mercan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Ismail Simsek
- Department of Neurosurgery, Pendik Research and Training Hospital, Marmara University, Turkey
| | - Hanife Sağlam
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Aynur Ozge
- Department of Neurology, School of Medicine, Mersin University, Turkey
| | - Derya Uluduz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey
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22
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Al-Hashel JY, Ahmed SF, Alroughani R. Prevalence and Burden of Primary Headache Disorders in Kuwaiti Children and Adolescents: A Community Based Study. Front Neurol 2019; 10:793. [PMID: 31417482 PMCID: PMC6682654 DOI: 10.3389/fneur.2019.00793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/09/2019] [Indexed: 01/11/2023] Open
Abstract
Background/Objective: Primary headaches are common in the pediatric and adolescent population and can be disabling for them and their families. We aimed to assess the prevalence and burden of primary headache disorders among children and adolescents in Kuwait. Methods: A cross-sectional community-based study included Kuwaiti population aged 6–17 years. They were randomly recruited from all six governorates of Kuwait using stratified multistage cluster sampling. The Headache-Attributed Restriction, Disability, and Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents was used to collect the data. Results: Data were collected from 3,423 subjects; 664 subjects were diagnosed as having primary headache disorders. The mean age was 12.61 ± 2.51 years and 64.2% were females. One year prevalence of headache was 19.4%. It was significantly prevalent in females compared to males (25.2% vs. 13.8%; P < 0.001). Primary headache disorder significantly increased in age group 12–17 when compared to age group 6–11 years (25.8% vs. 10.4 %; p < 0.001). One year primary headache prevalence showed non-significant differences in both males and females in age group 6–11 years (10.1% in males vs. 10.6% in females; P < 0.79), while it was significantly higher in female vs. males (38.1% vs. 15.8%; P < 0.001) in age group 12–17 years. Migraine prevalence was 10.9% followed by tension type headache (TTH) 6.2% and chronic headache 0.9%. Medical care utilization was reported in 67% of our cohort. The majority (95%) of the patients received symptomatic drugs for headache attacks and only 7.5% used preventive medication. The students with headache lost a mean of 1.29 ± 1.23 days of school, reported mean of 1.16 ± 1.50 days they could not do activities they had wanted to. Their parents lost a mean of 1.01 ± 1.02 days of work because of headaches of their children during the preceding 4 weeks of the study. Conclusions: The estimated 1 year prevalence of headache was 19.4% overall. Primary headache prevalence increased with age and it was more prevalent in female adolescents compared to males of the same age. Headache disorders in children/adolescents affect school and social activities as well as their parents work. The awareness for early diagnosis and preventive medications for headache in this age group may reduce the headache burden.
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Affiliation(s)
- Jasem Yousef Al-Hashel
- Neurology Department, Ibn Sina Hospital, Kuwait City, Kuwait.,Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Samar Farouk Ahmed
- Neurology Department, Ibn Sina Hospital, Kuwait City, Kuwait.,Division of Neurology, Amiri Hospital, Kuwait City, Kuwait
| | - Raed Alroughani
- Department of Neuropsychiatry, Minia University, Minia, Egypt
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23
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Nieswand V, Richter M, Berner R, von der Hagen M, Klimova A, Roeder I, Koch T, Sabatowski R, Gossrau G. The prevalence of headache in German pupils of different ages and school types. Cephalalgia 2019; 39:1030-1040. [DOI: 10.1177/0333102419837156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background/objective Headache in pupils is underestimated and has a negative impact on learning and life. The aim of this study was to investigate headache prevalence and its collateral effects, in pupils of different ages and school types in a German city. Methods Anonymized questionnaires were distributed to 5419 pupils attending primary and secondary schools. Demographics, headache frequency, analgesic use, school absence and, for secondary school children, data on lifestyle were collected. Results The questionnaire was returned by 2706 children (49%), 1362 (50.3%) girls, 1344 (49.7%) boys. Of these, 36.6% indicated a frequency of 1, and 31.5% a frequency of ≥ 2 headache days per month within the last 3 months. Headache prevalence increased with school grade, age and secondary school type: 63.6%, 67.2% and 79.5% for primary school children, pupils attending 8-year and pupils attending 6-year secondary schools, respectively. With secondary school level I certificates, pupils are prepared for general professional training in 6 years. Secondary school level II results, after 8 years of training, in university entrance level II certificates, which are the precondition for university studies. Girls reported significantly more headache than boys (73% vs. 63.1%). A significant relationship has been observed between headache frequency and school absence and between headache intensity and headache frequency. Of pupils with headache at least twice a month, 48.1% reported analgesic intake. Ibuprofen (49.1%) and paracetamol (32.8%) were the most frequently used analgesics. Of those pupils with headache ≥ 2 days/month, 68.3% did not have a specific headache diagnosis. Concomitant diseases and regular drug intake, analgesic intake for another reason than headache, caffeine consumption and lack of participation in sports were positively correlated with headache. Conclusions The majority of pupils suffer from headache at least once a month. Since frequent headache results in educational and social limitations, pupils at risk should be identified and referred to headache education programs. Efforts are needed to improve the management of juvenile headache patients.
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Affiliation(s)
- Vera Nieswand
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Matthias Richter
- Department of Pediatrics, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Maja von der Hagen
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anna Klimova
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
- Institute for Medical Informatics and Biometrics, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ingo Roeder
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
- Institute for Medical Informatics and Biometrics, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Rainer Sabatowski
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
- Department of Anesthesiology and Intensive Care Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Gudrun Gossrau
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
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24
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Fejes-Szabó A, Spekker E, Tar L, Nagy-Grócz G, Bohár Z, Laborc KF, Vécsei L, Párdutz Á. Chronic 17β-estradiol pretreatment has pronociceptive effect on behavioral and morphological changes induced by orofacial formalin in ovariectomized rats. J Pain Res 2018; 11:2011-2021. [PMID: 30310305 PMCID: PMC6165783 DOI: 10.2147/jpr.s165969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background The prevalence of craniofacial pain disorders show sexual dimorphism with generally more common appearance in women suggesting the influence of estradiol, but the exact cause remains unknown. The common point in the pathogenesis of these disorders is the activation of trigeminal system. One of the animal experimental models of trigeminal activation is the orofacial formalin test, in which we investigated the effect of chronic 17β-estradiol pretreatment on the trigeminal pain-related behavior and activation of trigeminal second-order neurons at the level of spinal trigeminal nucleus pars caudalis (TNC). Methods Female Sprague Dawley rats were ovariectomized and silicone capsules were implanted subcutaneously containing cholesterol in the OVX group and 17β-estradiol and cholesterol in 1:1 ratio in the OVX+E2 group. We determined 17β-estradiol levels in serum after the implantation of capsules. Three weeks after operation, 50 µL of physiological saline or 1.5% of formalin solution was injected subcutaneously into the right whisker pad of rats. The time spent on rubbing directed to the injected area and c-Fos immunoreactivity in TNC was measured as the formalin-induced pain-related behavior, and as the marker of pain-related neuronal activation, respectively. Results The chronic 17β-estradiol pretreatment mimics the plasma levels of estrogen occurring in the proestrus phase and significantly increased the formalin-induced pain-related behavior and neuronal activation in TNC. Conclusion Our results demonstrate that the chronic 17β-estradiol treatment has strong pronociceptive effect on orofacial formalin-induced inflammatory pain suggesting modulatory action of estradiol on head pain through estrogen receptors, which are present in the trigeminal system.
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Affiliation(s)
| | - Eleonóra Spekker
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary,
| | - Lilla Tar
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Gábor Nagy-Grócz
- MTA-SZTE Neuroscience Research Group, Szeged, Hungary, .,Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Bohár
- MTA-SZTE Neuroscience Research Group, Szeged, Hungary, .,Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary,
| | - Klaudia Flóra Laborc
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary, .,Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
| | - László Vécsei
- MTA-SZTE Neuroscience Research Group, Szeged, Hungary, .,Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary,
| | - Árpád Párdutz
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary,
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25
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Kang BS, Lee J, Choi JH, Kwon HH, Kang JW. Clinical manifestations of headache in children younger than 7 years. KOREAN JOURNAL OF PEDIATRICS 2018; 61:355-361. [PMID: 30304907 PMCID: PMC6258963 DOI: 10.3345/kjp.2018.06331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/16/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Headache is a common symptom during childhood. It is usually persistent and requires special care. This study aimed to identify the characteristics of headache in children <7 years of age. METHODS We reviewed 3 years of clinical files on children <7 years of age with a chief complaint of headache. RESULTS This study included 146 children (66 males, 80 females; mean age, 5.5±1.0 years). Mean symptom duration was 5.8±7.9 months. Attack durations were longer than 2 hours in 31 patients, shorter than 2 hours in 70 patients, and unchecked in 45 patients. Attack frequency was 15.1±10.6 times per month. Pain locations and characteristics were also variable. Mean pain severity score was 5.1±2.2 on the visual analog scale. Of 38 patients who underwent electroencephalography, 9 showed positive findings. Of 41 who underwent brain magnetic resonance imaging, 20 showed positive findings. The diagnoses were migraine (including probable migraine) in 34, tension-type headache in 5, and congenital malformations in 3. Medications were used in 29 patients: acetaminophen in 17, ibuprofen in 8, naproxen sodium in 1, and topiramate or amitriptyline in 3. CONCLUSION In children aged <7 years, headache has a relatively benign course, but detailed history taking is needed for more accurate diagnosis.
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Affiliation(s)
- Bu Seon Kang
- Department of Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jinsun Lee
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Hyuk Choi
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyeok Hee Kwon
- Department of Medical Science, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Joon Won Kang
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.,Department of Medical Science, College of Medicine, Chungnam National University, Daejeon, Korea.,Brain Research Institute, Chungnam National University School of Medicine, Daejeon, Korea
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26
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Aspinall N, D'Urso A, Ambegaonkar G. Fifteen minute consultation: an approach to the child with chronic headaches. Arch Dis Child Educ Pract Ed 2018; 103:177-183. [PMID: 29222182 DOI: 10.1136/archdischild-2016-312529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/17/2017] [Accepted: 11/13/2017] [Indexed: 11/03/2022]
Abstract
Children with chronic headache are a common referral to paediatric outpatients. This article suggests an approach to the assessment and management of chronic headaches, offering practical strategies for management as there is limited literature in paediatrics for this.
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Affiliation(s)
- Nichola Aspinall
- Paediatric Neurodisability, Royal College of Paediatrics and Child Health, Leeds, UK
| | - Anita D'Urso
- Department of Paediatrics, Bedford Hospitals NHS Trust, Bedford, UK
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27
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Jacobsena BA, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart JA. The Nord-Trøndelag Health Study shows increased prevalence of primary recurrent headaches among adolescents over a four-year period. Scand J Pain 2018; 2:148-152. [PMID: 29913741 DOI: 10.1016/j.sjpain.2011.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 03/12/2011] [Indexed: 11/15/2022]
Abstract
Objective Earlier epidemiological studies have shown that headaches are frequent among adolescents, especially girls. In particular, recurrent primary headache disorders such as migraine and tension-type headaches are common complaints in this age group. Headaches are increasingly being recognized as a significant health problem in adolescents and can lead to significant disabilities by affecting their lives, their school performance and their social lives. The aim of this study was to compare the prevalence of primary headaches among adolescents aged 16-20 years in Norway in two periods. Very few replicate studies have re-evaluated the prevalence of primary headaches in this age range and it is uncertain whether the prevalence is increasing. Methods Two cross-sectional, population-based studies were conducted in Norway from 1995 to 1997 (Young-HUNT 1) and from 1999 to 2001 (Young-HUNT 2). In Young-HUNT 1, 2594 adolescents in 2nd and 3rd grade in upper secondary school (aged 16-20 years) completed a comprehensive questionnaire including one question regarding headache during the last 12 months. In addition, 1730 of the students were interviewed about their headache complaints. In Young-HUNT 2, 2373 adolescents aged 16-20 years completed the same questionnaire and 1655 were interviewed in the same way as the earlier survey. The interviews were performed by trained nurses, and respondents were asked if they had experienced recurrent headache during the last year. If so, the headache was classified as migraine (MI), tensiontype headache (TTH) or non-classifiable headache (NCH). Headache frequency during the past year was recorded according to the following categories: Less than 1 day per month (less than monthly), 1-3 days per month (monthly), 1-5 days per week (weekly), or more than 5 days per week (daily). Results The participation rate was 88% in Young-HUNT 1 and 81% in Young-HUNT 2. The overall prevalence of having had headaches during the last 12 months did not change significantly (79.4% versus 77.5%; OR: 0.89, 95%CI: 0.79-1.02, p = 0.09), whereas the prevalence of recurrent headaches increased from 30.3% in Young-HUNT 1 to 35.4% in Young-HUNT 2 (OR: 1.26, 95%CI: 1.09-1.46, p = 0.002). The prevalence of tension-type headache changed significantly from 19.0% to 21.9% (OR: 1.20, 95%CI: 1.02-1.42, p = 0.03). Also the prevalence of migraine tended to increase (7.5% versus 8.7%, OR: 1.18, 95%CI: 0.92-1.52, p = 0.18). The overall frequency of recurrent headache changed towards more monthly and less weekly headache. Conclusions This is the first large-scale population-based study among adolescents in Norway assessing changes in the prevalence of primary headaches over a four-year period of time. The overall prevalence of recurrent headaches increased significantly from Young-HUNT 1 to Young-HUNT 2. An increase was seen in all types of recurrent headaches and was significant for tension-type headache. Implications Earlier follow-up studies have examined changes in prevalence of recurrent headaches in young age, but the results are diverging. Our findings support the impression that the prevalence of recurrent headache among adolescents is increasing, and underlines the need for prospective designed studies with emphasis on prognosis and etiological factors.
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Affiliation(s)
- Brit A Jacobsena
- Department of Neurology, Vestfold Hospital, Tønsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Grete Dyb
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Knut Hagen
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian National Headache Centre, Section of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - Lars J Stovner
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian National Headache Centre, Section of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - Turid L Holmen
- HUNT Research Centre, Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - John-Anker Zwart
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Ullevå,Oslo, Norway.,Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,National Centre for Spinal Disorders, St. Olavs Hospital, Trondheim, Norway
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28
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Jeong YJ, Lee YT, Lee IG, Han JY. Primary headaches in children and adolescents - experiences at a single headache center in Korea. BMC Neurol 2018; 18:70. [PMID: 29783930 PMCID: PMC5961492 DOI: 10.1186/s12883-018-1073-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 05/07/2018] [Indexed: 11/20/2022] Open
Abstract
Background Headache is a common complaint in children and adolescents. Recently, an increased prevalence of headache in children and adolescents has been reported. Methods We retrospectively reviewed the medical records of children and adolescents attending the Headache Clinic of Daejeon St. Mary’s Hospital during the period from January 2005 through December 2016. Results The study population consisted of 2466 children, aged between 3 and 18 years (mean age: 10.9). Our study showed an increase in the number of patients visiting the hospital with headaches during the past decade. Compared with 2005, the number of patients with headache increased three-fold in 2016. Interestingly, the proportion of boys, preschool children, and other primary headaches revealed a steady and statistically significant increase. Conclusion Due to a steady increase in pediatric headaches, the earlier the problem is recognized and properly diagnosed and a treatment plan is established, the greater the likelihood of a better lifelong outcome. Studies are needed to estimate recent trend in prevalence and to identify the demographic and socioeconomic factors predicting the occurrence of headache.
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Affiliation(s)
- Yun Jin Jeong
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Yun Tae Lee
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - In Goo Lee
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Yoon Han
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
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29
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Foiadelli T, Piccorossi A, Sacchi L, De Amici M, Tucci M, Brambilla I, Marseglia GL, Savasta S, Verrotti A. Clinical characteristics of headache in Italian adolescents aged 11-16 years: a cross-sectional questionnaire school-based study. Ital J Pediatr 2018; 44:44. [PMID: 29618369 PMCID: PMC5885291 DOI: 10.1186/s13052-018-0486-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/26/2018] [Indexed: 12/16/2022] Open
Abstract
Background The purpose of this study was to determine headache characteristics, impact on daily activities and medication attitudes among a large sample of adolescents in Italy. Methods Secondary school classes were randomly selected from a national stratified multistage sampling. Data regarding socio-familial factors, headache characteristics, impact on daily activities and medication use were recorded with an anonymous multiple-choice questionnaire. Results The survey involved 2064 adolescents. 1950 questionnaires were considered for analysis. Study population included 944 males (48.4%) and 1006 females (51.6%), aged between 11 and 16 years (mean 13.5 ± 1.87). Headache prevalence was 65.9%. Mean age at headache onset was 8.33 years. 9.8% suffered from headache > 1/week, 14.3% > 1/month, 24.2% monthly and 17.7% less than monthly. The mean duration of a headache episode was less than 30 min in 32.9%, 1 hour in 28.1%, 2 hours in 19.3% and several hours in 19.5%. Pain intensity was moderate in 52.2% and severe in 9.5%. School represented the main trigger factor (67%). Impact on daily activities was noted in 57.5%. 69.2% of adolescents reported the use of pain relievers. Up to 5.7% declared self-medication, while only 20.6% followed a physician’s prescription. Female adolescents experienced headache more frequently (70.2% vs 60%) and more intensely than male peers. Girls had a higher family history of headache, could more frequently identify a trigger factor, and were more affected into their daily activities than boys. Conclusions Population-based studies of headache disorders are important, as they inform needs assessment and underpin service policy for a disease that is a public-health priority. Headache has a high prevalence among adolescents and carries a significant burden in terms of impact on daily activities and use of medication. Furthermore, underdiagnose is common, while trigger factors are often detectable. Special consideration should be given to female adolescents and self-medication attitudes.
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Affiliation(s)
- Thomas Foiadelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy.
| | - Alessandra Piccorossi
- Department of Pediatrics, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Lucia Sacchi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Mara De Amici
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | | | - Ilaria Brambilla
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | - Salvatore Savasta
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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30
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Johansson AM, Vikingsson H, Varkey E. The physiotherapist, an untapped resource for headaches: a survey of university students. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2017.1352023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anna-Maria Johansson
- Department of Health and Rehabilitation/Physiotherapy, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hannah Vikingsson
- Department of Health and Rehabilitation/Physiotherapy, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emma Varkey
- Department of Health and Rehabilitation/Physiotherapy, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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31
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Balestri M, Papetti L, Maiorani D, Capuano A, Tarantino S, Battan B, Vigevano F, Valeriani M. Features of aura in paediatric migraine diagnosed using the ICHD 3 beta criteria. Cephalalgia 2017; 38:1742-1747. [PMID: 29239213 DOI: 10.1177/0333102417748571] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background In children and adolescents, the prevalence rate of migraine with aura is 1.6%. Few studies concerning migraine with aura features in paediatric population have been reported. Aim The aim of our study was to investigate clinical features of aura in a retrospective cohort of children with migraine with aura. Furthermore, we studied whether the International Classification of Headache Disorder (ICHD) 3 beta version criteria could efficiently detect migraine with aura in a paediatric population. Results We included 164 patients who experienced aura associated with headache (mean age 9.92 ± 2.64 years). When the ICHD-II criteria were used, a final diagnosis of migraine with typical aura was obtained in 15.3% of patients, probable migraine with typical aura in 13.4%, and typical aura with headache in 61.8%, while in in 9.5% of patients the diagnosis was undetermined. According to ICHD-3 beta, we diagnosed migraine with typical aura in 77.7% of patients, probable migraine with typical aura in 13.4%, and an undetermined diagnosis in 9.5% (less than two attacks). Conclusion Aura features did not depend on age and were similar to those of adults. However, the headache could be difficult to classify if headache duration was considered. In this view, the ICHD-3 beta offers the advantage of not considering headache features, including pain duration, for the diagnosis of migraine with typical aura, thus making this diagnosis easier in children and adolescents.
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Affiliation(s)
- Martina Balestri
- 1 Headache Centre, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Laura Papetti
- 1 Headache Centre, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | | | - Samuela Tarantino
- 1 Headache Centre, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Barbara Battan
- 1 Headache Centre, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Federico Vigevano
- 1 Headache Centre, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Massimiliano Valeriani
- 1 Headache Centre, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.,3 Centre for sensory motor interaction, Aalborg University, Aalborg, Denmark
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Goto M, Yokoyama K, Nozaki Y, Itoh K, Kawamata R, Matsumoto S, Yamagata T. Characteristics of headaches in Japanese elementary and junior high school students: A school-based questionnaire survey. Brain Dev 2017; 39:791-798. [PMID: 28578816 DOI: 10.1016/j.braindev.2017.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE Few studies have investigated pediatric headaches in Japan. Thus, we examined the lifetime prevalence and characteristics of headaches among elementary and junior high school students in Japan. METHODS In this school-based study, children aged 6-15years completed a questionnaire based on the diagnostic criteria of the International Classification of Headache Disorders-3β to assess headache characteristics and related disability. RESULTS Of the 3285 respondents, 1623 (49.4%) experienced headaches. Migraine and tension-type headaches (TTH) were reported by 3.5% and 5.4% of elementary school students, respectively, and by 5.0% and 11.2% of junior high school students. Primary headaches increased with age. Compared with TTH sufferers, the dominant triggers in migraine sufferers were hunger (odds ratio=4.7), sunny weather (3.3), and katakori (neck and shoulder pain) (2.5). Compared with TTH, migraine caused higher headache-related frustration (P=0.010) as well as difficulty concentrating (P=0.017). Migraine-related disability was greater among junior high school students (feeling fed up or irritated, P=0.028; difficulty concentrating, P=0.016). TTH-related disability was also greater among junior high school students (feeling fed up or irritated, P=0.035). Approximately half of the students who complained of headache-related disability were not receiving medical treatment. CONCLUSION This is the first detailed study of headaches in Japanese children to include elementary school students. Nearly 50% of the school children reported headaches and the disruption of daily activities caused by migraine was higher among junior high students than elementary school students.
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Affiliation(s)
- Masahide Goto
- Department of Pediatrics, Hitachiomiya Saiseikai Hospital, Hitachiomiya, Ibaraki, Japan; Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Koji Yokoyama
- Department of Pediatrics, Hitachiomiya Saiseikai Hospital, Hitachiomiya, Ibaraki, Japan; Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yasuyuki Nozaki
- Department of Pediatrics, Hitachiomiya Saiseikai Hospital, Hitachiomiya, Ibaraki, Japan; Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koichi Itoh
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Hitachiomiya, Ibaraki, Japan; Rikuzen-Takata Clinic, Social Welfare Organization Saiseikai Imperial Gift Foundation, Iwate, Japan
| | - Ryou Kawamata
- Department of Pediatrics, Hitachiomiya Saiseikai Hospital, Hitachiomiya, Ibaraki, Japan
| | - Shizuko Matsumoto
- Department of Pediatrics, Hitachiomiya Saiseikai Hospital, Hitachiomiya, Ibaraki, Japan
| | - Takanori Yamagata
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Sillanpää M, Saarinen MM. Long term outcome of childhood onset headache: A prospective community study. Cephalalgia 2017; 38:1159-1166. [DOI: 10.1177/0333102417727536] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To examine prevalence, course, and long-term outcome of childhood migraine and other headaches. Method Using questionnaires, 1185 children were followed for recurrent headaches at ages seven, 14 and 32 years, respectively. Results At age seven years, 4.0% of the 1185 children (girls 3.7%, boys 4.3%) had migraine and 24% (25%/23%) had nonmigrainous headache. In adulthood, 16% (22%/8%) had migraine and 60% (64%/54%) nonmigrainous headache. Childhood migraine persisted into adulthood in 65% of females and 21% of males, and nonmigrainous headache in 62% and 59%, respectively. After childhood, 17% of females and 7% of males started to have episodes of migraine. No recurrent headache during the follow-up was reported by 11% (6%/16%). In a multivariate analysis, compared with no childhood headache, childhood migraine increased the risk of adulthood migraine by 3.36-fold (95% CI 1.94–5.82) and that of nonmigrainous headache by 1.72-fold (1.14–2.60). Discussion and conclusions Headaches are generally as common in preschool girls as boys. From early school years, headaches steadily increase up to young adulthood, but among boys the prevalence levels off after adolescence. About two thirds of children experienced changes in their headache status during a 25-year follow-up. Any kind of recurrent headache at school entry predicts an increased risk of headache in young adulthood. Special attention should be paid to girls and particularly those girls who have recurrent headache when they start school.
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Affiliation(s)
- Matti Sillanpää
- Department of Child Neurology, University of Turku, Turku, Finland
- Department of General Practice, University of Turku, Turku, Finland
| | - Maiju M Saarinen
- Department of Child Neurology, University of Turku, Turku, Finland
- Department of General Practice, University of Turku, Turku, Finland
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Cadiot D, Longuet R, Bruneau B, Treguier C, Carsin-Vu A, Corouge I, Gomes C, Proisy M. Magnetic resonance imaging in children presenting migraine with aura: Association of hypoperfusion detected by arterial spin labelling and vasospasm on MR angiography findings. Cephalalgia 2017; 38:949-958. [DOI: 10.1177/0333102417723570] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective A child presenting with a first attack of migraine with aura usually undergoes magnetic resonance imaging (MRI) to rule out stroke. The purpose of this study was to report vascular and brain perfusion findings in children suffering from migraine with aura on time-of-flight MR angiography (TOF-MRA) and MR perfusion imaging using arterial spin labelling (ASL). Methods We retrospectively included all children who had undergone an emergency MRI examination with ASL and TOF-MRA sequences for acute neurological deficit and were given a final diagnosis of migraine with aura. The ASL perfusion maps and TOF-MRA images were independently assessed by reviewers blinded to clinical data. A mean cerebral blood flow (CBF) value was obtained for each cerebral lobe after automatic data post-processing. Results Seventeen children were finally included. Hypoperfusion was identified in one or more cerebral lobes on ASL perfusion maps by visual assessment in 16/17 (94%) children. Vasospasm was noted within the intracranial vasculature on the TOF-MRA images in 12/17 (71%) children. All (100%) of the abnormal TOF-MRA images were associated with homolateral hypoperfusion. Mean CBF values were significantly lower ( P < 0.05) in visually hypoperfused lobes than in normally perfused lobes. Conclusion ASL and TOF-MRA are two totally non-invasive, easy-to-use MRI sequences for children in emergency settings. Hypoperfusion associated with homolateral vasospasm may suggest a diagnosis of migraine with aura.
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Affiliation(s)
- Domitille Cadiot
- CHU Rennes, Department of Radiology, Pediatric Imaging, Rennes, France
| | | | - Bertrand Bruneau
- CHU Rennes, Department of Radiology, Pediatric Imaging, Rennes, France
| | | | - Aline Carsin-Vu
- INSERM U1228, Unité Visage, CNRS UMR 6074, Université de Rennes I, Rennes, France
| | - Isabelle Corouge
- INSERM U1228, Unité Visage, CNRS UMR 6074, Université de Rennes I, Rennes, France
| | | | - Maïa Proisy
- CHU Rennes, Department of Radiology, Pediatric Imaging, Rennes, France
- INSERM U1228, Unité Visage, CNRS UMR 6074, Université de Rennes I, Rennes, France
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Zhou W, Li J, Birmingham B, Xu H, Lillieborg S, Zhou D, Al-Huniti N. Population Pharmacokinetic Analysis of Zolmitriptan and Its Metabolite in Adults and Adolescents to Support Dose Selection in Children With Migraine. J Clin Pharmacol 2017; 57:1258-1267. [PMID: 28581633 DOI: 10.1002/jcph.935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/11/2017] [Indexed: 11/09/2022]
Abstract
Zolmitriptan is a serotonin (5-HT) 1B/1D receptor agonist effective for the treatment of migraine. This analysis aimed to develop a population pharmacokinetic (PK) model for zolmitriptan and its active metabolite in adults and adolescents and provide appropriate dosing regimens to be used in clinical trials for children 6-11 years old. The data from a single-dose clinical study of 5.0-mg zolmitriptan nasal spray (ZNS) conducted in adult and adolescent patients with migraine between migraine attacks was applied. Similar plasma concentration profiles of zolmitriptan and its metabolite, 183C91, were observed in adults and adolescents. A 1-compartment model with first-order absorption and first-order elimination reasonably described the zolmitriptan PK. With a portion of elimination of zolmitriptan being treated as the conversion from zolmitriptan to 183C91, the disposition of 183C91 was described by a 1-compartment model with first-order elimination. The estimated typical apparent volume of distribution and clearance of zolmitriptan were 136 L and 121 L/h, respectively, with 56.5% and 42.6% between-subject variability, respectively. Based on the simulation results with the final population PK model, a body weight-based dosing scheme of 5.0 and 2.5 mg ZNS in children greater than and less than 50 kg is recommended to achieve exposures similar to those of the adult and adolescent population administered 5.0 mg ZNS. The recommended doses for children to achieve exposure similar to that observed in adults given 2.5 mg ZNS are 2.5 mg (≥50 kg) and 1.0 mg (15-50 kg). These dosing regimens could be used in future clinical trials.
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Affiliation(s)
- Wangda Zhou
- Quantitative Clinical Pharmacology, AstraZeneca, Waltham, MA, USA
| | - Jianguo Li
- Quantitative Clinical Pharmacology, AstraZeneca, Waltham, MA, USA
| | | | - Hongmei Xu
- Quantitative Clinical Pharmacology, AstraZeneca, Waltham, MA, USA
| | | | - Diansong Zhou
- Quantitative Clinical Pharmacology, AstraZeneca, Waltham, MA, USA
| | - Nidal Al-Huniti
- Quantitative Clinical Pharmacology, AstraZeneca, Waltham, MA, USA
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Kröner-Herwig B, Gorbunova A, Maas J. Predicting the occurrence of headache and back pain in young adults by biopsychological characteristics assessed at childhood or adolescence. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2017; 8:31-39. [PMID: 28405174 PMCID: PMC5378444 DOI: 10.2147/ahmt.s127501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of the current study was to identify predictors of recurrent headache and back pain in young adults (aged 18–27 years) from data assessed in childhood or adolescence, i.e., 9 years before the final survey. Our interest was whether psychological characteristics contribute to the risk of pain prevalence in adult age when controlling for already empirically supported risk factors such as parental pain, pediatric pain and sex. The study was part of a five-wave epidemiological investigation of >5000 families with children aged between 7 and 14 years when addressed first. In a multiple hierarchical regression analysis, the abovementioned three variables (Block-I variables) were entered first followed by five psychological trait variables (Block-II variables: internalizing, anxiety sensitivity, somatosensory amplification, catastrophizing and dysfunctional stress coping) to find out the extent of model improvement. The multivariable hierarchical regression analysis confirmed the hypothesis that the Block-I variables significantly enhance the risk of future pain at young adult age. None of the psychological variables did so. Thus, the hypothesis of a significant surplus predictive effect was not confirmed. The amount of total explained variance differed strongly between headache and back pain. In particular, a valid prediction of back pain was not possible. When analyzed separately in simple regression analysis, psychological variables turned out to be significant predictors, however, of very low effect size. The inclusion of Block-I variables in the model clearly reduced the impact of the psychological variables. This risk profile is discussed in the context of the different trajectories of headache and back pain from childhood to adult age, which were proposed by various studies. We propose that a biopsychological characteristic denoted as emotional negativity, especially regarding self-reference, might be a common factor behind all selected variables. Risk research in recurrent pain is a field where much more multidisciplinary research is needed before progress can be expected.
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Affiliation(s)
- Birgit Kröner-Herwig
- Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institute of Psychology, University of Göttingen, Göttingen, Germany
| | - Anastasia Gorbunova
- Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institute of Psychology, University of Göttingen, Göttingen, Germany
| | - Jennifer Maas
- Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institute of Psychology, University of Göttingen, Göttingen, Germany
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Isensee C, Hagmayer Y, Fernandez Castelao C, Kröner-Herwig B. Paediatric headache trajectories – a reappraisal after nine years. Cephalalgia 2017; 38:487-495. [DOI: 10.1177/0333102417694803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The long-term consequences of paediatric headache can involve functional disabilities and mental health problems in adulthood. Objective To analyse the predictive power of paediatric headache trajectory classes for headache and related outcomes in adulthood. Methods In a previous study, a population-based sample (N = 3227, 9–14 years of age at first assessment) was followed across four annual assessment points, and sex-specific headache trajectory classes were identified (girls: “no pain”, “moderate pain”, “increasing pain”, “high pain”; boys: “no pain”, “moderate pain”). These trajectory classes were used to predict headache frequency, functional disability, depression, quality of life and self-efficacy nine years later (N = 994). Negative binomial regression analyses and pairwise comparisons were computed. Results Women showing an elevated trajectory (“increasing pain” or “high pain”) had a higher adult headache frequency and a poorer outcome on associated variables (functional disability, depression, quality of life, and self-efficacy) than women having a lower-level trajectory. Men of the “no pain” and “moderate pain” trajectory classes differed significantly from one another in their headache frequency and related variables. Conclusion Belonging to an elevated paediatric headache trajectory class involves a considerable risk for headache and headache-related problems in adulthood.
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Affiliation(s)
- Corinna Isensee
- Department of Psychology, University of Göttingen, Göttingen, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
| | - York Hagmayer
- Department of Psychology, University of Göttingen, Göttingen, Germany
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Rho YI. Prevalence of headache and headache-related disability in children and adolescents. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.2.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Young-Il Rho
- Department of Pediatrics, Chosun University School of Medicine, Gwangju, Korea
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Laurell K, Larsson B, Mattsson P, Eeg-Olofsson O. A 3-Year Follow-Up of Headache Diagnoses and Symptoms in Swedish Schoolchildren. Cephalalgia 2016; 26:809-15. [PMID: 16776695 DOI: 10.1111/j.1468-2982.2006.01113.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Information is sparse concerning the incidence and prognosis of headache in children from the general population, especially of tension-type headache. In this study, headache diagnoses and symptoms were reassessed in 122 out of 130 schoolchildren after 3 years. Nearly 80± of those with headache at first evaluation still reported headache at follow-up. Although the likelihood of experiencing the same headache diagnosis and symptoms was high, about one-fifth of children with tension-type headache developed migraine and vice versa. Female gender predicted migraine and frequent headache episodes predicted overall headache at follow-up. The estimated average annual incidence was 81 and 65 per 1000 children, for tension-type headache and migraine, respectively. We conclude that there is a considerable risk of developing and maintaining headache during childhood. Headache diagnoses should be reassessed regularly and treatment adjusted. Girls and children with frequent headache have a poorer prognosis and therefore intervention is particularly important in these groups.
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Affiliation(s)
- K Laurell
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.
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Abstract
AbstractChronic daily headache (CDH) is a multi-faceted, often complex pain syndrome in children and adolescents. Chronic daily headache may be primary or secondary. Chronic migraine and chronic tension-type are the most frequent subtypes. Chronic daily headache is co-morbid with adverse life events, anxiety and depressive disorders, possibly with other psychiatric disorders, other pain syndromes and sleep disorders; these conditions contribute to initiating and maintaining CDH. Hence, early management of episodic headache and treatment of associated conditions are crucial to prevention. There is evidence for the benefit of psychological therapies, principally relaxation and cognitive behavioral, and promising information on acupuncture for CDH. Data on drug treatment are based primarily on open label studies. The controversies surrounding CDH are discussed and proposals for improvement presented. The multifaceted nature of CDH makes it a good candidate for a multi-axial classification system. Such an approach should facilitate biopsychosocial management and enhance consistency in clinical research.
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Premonitory symptoms in migraine: A cross-sectional study in 2714 persons. Cephalalgia 2016; 36:951-9. [DOI: 10.1177/0333102415620251] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/04/2015] [Indexed: 01/03/2023]
Abstract
Aim To describe the frequency and number of premonitory symptoms (PS) in migraine, the co-occurrence of different PS, and their association with migraine-related factors. Methods In this cross-sectional study, a validated questionnaire was sent to Finnish migraine families between 2002 and 2013 to obtain data on 14 predefined PS, migraine diagnoses, demographic factors, and migraine characteristics. The estimated response rate was 80%. Results Out of 2714 persons, 2223 were diagnosed with migraine. Among these, 77% reported PS, with a mean number of 3.0 symptoms compared to 30% ( p < 0.001) and 0.5 symptoms ( p < 0.001) among 491 persons with non-migraine headaches. Yawning was the most commonly reported symptom (34%) among migraineurs. Females reported PS more frequently than males (81 versus 64%, p < 0.001) and experienced a higher number of different symptoms (mean 3.3 versus 1.8, p < 0.001). All measures of migraine severity were associated with a higher burden of PS. Light and sound sensitivity showed the highest co-occurrence (kappa = 0.51, 95% CI 0.47–0.55). In a generalized linear model, age, gender, higher frequency, duration and intensity of headache, reduced working capacity, most aura symptoms, and associated symptoms of the headache phase were significantly associated with an increased in the number of PS. Conclusion PS are experienced by a majority of migraineurs. More severe migraine is associated with a higher burden of PS. Since the material was not entirely representative of the general population of migraineurs, caution should be exercised in generalizing the results.
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Fendrich K, Vennemann M, Pfaffenrath V, Evers S, May A, Berger K, Hoffmann W. Headache Prevalence Among Adolescents — The German DMKG Headache Study. Cephalalgia 2016; 27:347-54. [PMID: 17376112 DOI: 10.1111/j.1468-2982.2007.01289.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This population-based cross-sectional study examined the 3-month prevalence of headache, migraine and tension-type headache (TTH) among adolescents aged 12-15 years in Germany Students ( n = 3324) from 20 schools completed a questionnaire on general and headache-specific pain which included a sociodemographic module. The headache-specific questionnaire complied with the respective revised criteria of the International Headache Society (IHS). 'Modified criteria' changed the item 'duration' in migraine (>30 min instead of >4 h). The overall 3-month prevalence of headache was 69.4% (boys 59.5%, girls 78.9%), with 4.4% of the adolescents suffering from frequent (≥ 14 days/3 months) and severe (grade 8-10 on a 10-point visual analogue scale) headache and 1.4% (boys 0.9%, girls 1.9%) from headache ≥15 days/month. The 3-month prevalence of migraine was 2.6% (boys 1.6%, girls 3.5%) applying strict IHS criteria and 6.9% (boys 4.4%, girls 9.3%) with modified criteria; 12.6% (boys 8.3%, girls 16.7%) suffered from probable migraine, 0.07% fulfilled the criteria for chronic migraine, 4.5% (boys 4.6%, girls 4.3%) suffered from TTH, 0.2% from chronic TTH and 15.7% (boys 14.5%, girls 16.9%) from probable TTH. Headache and migraine were more common in girls than in boys and in teenagers, especially in girls, aiming at higher education. Recurrent headache and primary headache disorders are common complaints among German adolescents, especially among girls.
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Affiliation(s)
- K Fendrich
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University of Greifswald, Greifswald, Germany
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Akyol A, Kiylioglu N, Aydin I, Erturk A, Kaya E, Telli E, Akyildiz U. Epidemiology and Clinical Characteristics of Migraine Among School Children In The Menderes Region. Cephalalgia 2016; 27:781-7. [PMID: 17598759 DOI: 10.1111/j.1468-2982.2007.01343.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The goal of this study was to collect and analyse information on the prevalence of childhood migraine and disability due to migraine in primary school children of 4th to 8th grades (ages ranging from 9 to 17 years) in the Aydin urban area. A cross-sectional school-based study was conducted between March and June 2004. There were 76 333 children of 4th to 8th grades in primary schools in Aydin. Nearly 10% of this population (7721 out of 76 333) was evaluated by a multistage clustered sampling procedure. Four questionnaire forms were applied to each child by a study neurologist during class time. Questionnaire A consisted of a single question, ‘Have you ever had a headache?’. To those who responded ‘yes’, questionnaire B was applied as a second step, which consisted of eight questions. Diagnosis of migraine headache was made according to International Classification of Headache Disorders 2004. Migraine disability was measured with questionnaire C, which was originally the Pediatric Migraine Disability Assessment (PedMIDAS). Migraine history, previous migraine diagnosis and pain intensity were measured with questionnaire D. According to questionnaire A, 79.6% of boys and 87.1% of girls suffered from headaches. The prevalence of migraine was 9.7% (7.8% in boys, 11.7% in girls) according to questionnaire B. The male:female ratio was 1:1.5. Total PedMIDAS score was 9.94 ± 8.41 days in boys and 11.50 ± 12.28 days in girls. Only 1.9% of the children had previously been diagnosed with migraine. The average migraine headache history was 2.48 ± 1.18 years in girls and 2.57 ± 1.18 years in boys. Although migraine is a common health problem among school children in Aydin, it is mostly still under-recognized.
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Affiliation(s)
- A Akyol
- Adnan Menderes University, Faculty of Medicine, Deparment of Neurology, Aydin, Turkey.
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Trautmann E, Lackschewitz H, Kröner-Herwig B. Psychological Treatment of Recurrent Headache in Children and Adolescents - A Meta-Analysis. Cephalalgia 2016; 26:1411-26. [PMID: 17116091 DOI: 10.1111/j.1468-2982.2006.01226.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Psychologically based interventions such as relaxation training, biofeedback and cognitive-behavioural therapy are increasingly discussed as options for the treatment of migraine and tension-type headache in children and adolescents. In order to determine the state of evidence regarding the efficacy of these treatments, a meta-analysis of randomized controlled studies was conducted. In a comprehensive literature search including data from 1966 to 2004, 23 studies were found meeting the inclusion criteria. Due to the application of the random effects model, generalization of the results is possible. Specific statistical procedures were used to account for a possible publication bias. Significantly more patients improved to a clinically relevant extent (headache reduction ≥50%) in treatment conditions compared with waiting list conditions (high effect sizes). Long-term stability was also confirmed. The analysed treatments lead to improvement (up to 1 year) in headache status in children and adolescents with primary headache. However, more well-designed studies are needed to support and consolidate the conclusions of this meta-analysis and to compare the effects of psychological treatment with those of prophylactic medical interventions (in migraine), to examine potential differences between treatments, to identify moderators of efficacy and to determine effects of treatment on other health- related variables such as quality of life.
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Affiliation(s)
- E Trautmann
- Department of Clinical Psychology and Psychotherapy, University of Göttingen, Gosserstrasse 14, 37073 Göttingen, Germany
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Genizi J, Khourieh Matar A, Schertz M, Zelnik N, Srugo I. Pediatric mixed headache -The relationship between migraine, tension-type headache and learning disabilities - in a clinic-based sample. J Headache Pain 2016; 17:42. [PMID: 27102119 PMCID: PMC4840135 DOI: 10.1186/s10194-016-0625-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/07/2016] [Indexed: 01/03/2023] Open
Abstract
Background Headache is a common complaint among children. The most common primary headache syndromes in childhood are migraine and TTH. However many times they seem to overlap. The purpose of our study was to assess the relationship between pediatric migraine, tension-type headache (TTH) and learning disabilities. Methods Children presenting with headache to three pediatric neurology clinics in the last 5 years were assessed. Two hundred sixty-two children, 5–18 years of age, who met the criteria for migraine were included. Results Of 262 children (54 % female) who had migraine, 26.2 % had migraine with aura. 59 children (22.5 % of the full sample) reported also having headaches that met the criteria for episodic TTH/mixed headaches. Females were more than 2.8 times more likely to experience mixed headaches than males (OR: 2.81, 95 % CI: 1.43–5.54; p <.003). Multiple logistic regression analysis revealed that older age (p <0.02), family history of aura (p <.02), and (lack of) TTH (p <.003) were significant predictors of aura, whereas gender was not significant (p >0.20). Children who had migraine with aura were less likely to have mixed headaches than children who did not have aura (OR: 0.26, 95 % CI: 0.11–0.63; p <.003). Children with mixed headaches were 2.7 times more likely to have a learning disability than children with migraine alone. Conclusions Episodic TTH and migraine without aura (mixed headaches) in children might be part of a continuum, which can explain the high incidence of their co-occurrence as opposed to migraine with aura. Children with mixed headaches have a higher incidence of learning disability compare to those with migraine alone.
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Affiliation(s)
- Jacob Genizi
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel. .,Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel. .,Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | | | - Mitchell Schertz
- Child Development & Pediatric Neurology Service, Meuhedet - Northern Region, Haifa, Israel
| | - Nathanel Zelnik
- Pediatric Neurology Unit, Carmel Medical Center, Haifa, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Isaac Srugo
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Isensee C, Fernandez Castelao C, Kröner-Herwig B. Developmental trajectories of paediatric headache - sex-specific analyses and predictors. J Headache Pain 2016; 17:32. [PMID: 27076175 PMCID: PMC4830779 DOI: 10.1186/s10194-016-0627-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/07/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Headache is the most common pain disorder in children and adolescents and is associated with diverse dysfunctions and psychological symptoms. Several studies evidenced sex-specific differences in headache frequency. Until now no study exists that examined sex-specific patterns of change in paediatric headache across time and included pain-related somatic and (socio-)psychological predictors. METHOD Latent Class Growth Analysis (LCGA) was used in order to identify different trajectory classes of headache across four annual time points in a population-based sample (n = 3 227; mean age 11.34 years; 51.2 % girls). In multinomial logistic regression analyses the influence of several predictors on the class membership was examined. RESULTS For girls, a four-class model was identified as the best fitting model. While the majority of girls reported no (30.5 %) or moderate headache frequencies (32.5 %) across time, one class with a high level of headache days (20.8 %) and a class with an increasing headache frequency across time (16.2 %) were identified. For boys a two class model with a 'no headache class' (48.6 %) and 'moderate headache class' (51.4 %) showed the best model fit. Regarding logistic regression analyses, migraine and parental headache proved to be stable predictors across sexes. Depression/anxiety was a significant predictor for all pain classes in girls. Life events, dysfunctional stress coping and school burden were also able to differentiate at least between some classes in both sexes. CONCLUSIONS The identified trajectories reflect sex-specific differences in paediatric headache, as seen in the number and type of classes extracted. The documented risk factors can deliver ideas for preventive actions and considerations for treatment programmes.
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Affiliation(s)
- Corinna Isensee
- />Georg-Elias-Müller-Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Göttingen, Gosslerstraße 14, 37073 Göttingen, Germany
- />Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Göttingen, Göttingen, Germany
| | - Carolin Fernandez Castelao
- />Georg-Elias-Müller-Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Göttingen, Gosslerstraße 14, 37073 Göttingen, Germany
| | - Birgit Kröner-Herwig
- />Georg-Elias-Müller-Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Göttingen, Gosslerstraße 14, 37073 Göttingen, Germany
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Krogh AB, Larsson B, Salvesen Ø, Linde M. Assessment of headache characteristics in a general adolescent population: a comparison between retrospective interviews and prospective diary recordings. J Headache Pain 2016; 17:14. [PMID: 26910064 PMCID: PMC4766176 DOI: 10.1186/s10194-016-0602-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/10/2016] [Indexed: 01/03/2023] Open
Abstract
Background Reliable information on headache characteristics, including frequency and intensity, headache-associated impairment, and use of analgesic medications, may depend on the assessment method used. This study analyzed the correlations between headache characteristics determined in structured interviews and those determined in prospective diary recordings kept by adolescents in the general population. Methods In this cross-sectional school-based study, a representative sample of 488 adolescents aged 12–18 years were interviewed about headaches experienced during the previous year. Headache diaries for a three-week period were kept by 393 participants: 244 girls (62 %) and 149 (38 %) boys. Results Most adolescents (88 %) who reported headaches during their interview also recorded headaches in their diary. In contrast, 51 % of those who reported being headache-free during the last year recorded headaches in their diary. In the interviews, frequent headaches (at least 50 % of days during the last year) were reported by 2.9 % of participants, while 25.5 % reported this headache frequency in their diary. Overall, the ratings of headache frequency were significantly higher in diaries than in interviews (p < 0.001). Significant but low correlations were observed between intensity levels reported retrospectively and prospectively (rho = 0.28; p < 0.001) and between average scores of headache-related impairment reported retrospectively and prospectively (rho = 0.35; p < 0.001). The use of medications by those who reported one or more current headache disorder during their interview was significantly lower in prospective recordings than in the retrospective interview estimates (p < 0.001). Conclusions There is inconsistency in the estimates of headache characteristics between retrospective reports and diary recordings. A comprehensive picture of headache complaints among adolescents may be better obtained through a combination of prospective diary recordings and interviews by school health and clinical services.
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Affiliation(s)
- Anne-Berit Krogh
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, N-7489, Trondheim, Norway. .,Faculty of Health and Social Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Bo Larsson
- Regional Centre for Child and Youth Mental Health and Child Welfare, Central Norway, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Øyvind Salvesen
- Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Mattias Linde
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, N-7489, Trondheim, Norway. .,Norwegian Advisory Unit on Headaches, St. Olav's University Hospital, Trondheim, Norway.
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Abstract
The objectives of this systematic review were to examine age dependency of headache prevalence in school age children and to assess secular trends of headache prevalence in the last decade, gender and regional differences. A literature search was performed in MEDLINE to identify all prevalence studies in children and adolescents. Five hundred seventy studies were found, of which 37 studies could be included for this review. Headache prevalence in school children increases with their age as demonstrated in cohorts of identical children and cross-sectional surveys covering different age groups of children in one population. Regarding a potential general increase in the prevalence of headache in children and adolescents in the last decade, there are four studies which all show some increase of headache prevalence; however, the degree of increase is varying. Prevalence of headache in girls appears to be higher than in boys. There were no clear regional differences in the prevalence of headache.
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Genizi J, Khourieh Matar A, Zelnik N, Schertz M, Srugo I. Frequency of pediatric migraine with aura in a clinic-based sample. Headache 2015; 56:113-7. [PMID: 26790850 DOI: 10.1111/head.12741] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the prevalence and risk factors for pediatric migraine with aura (MWA) among patients presenting to pediatric neurology clinics. BACKGROUND Headache is a common complaint among children, and the prevalence of migraine is about 8%. Up to one third of adults with migraine report experiencing aura; however, the exact percentage in children is unknown. METHODS Medical records of children presenting with headache to three pediatric neurology clinics in Haifa in the last 5 years were retrospectively reviewed. Inclusion criteria were a diagnosis of migraine headache at 5-18 years of age. RESULTS Of 260 children (140 female) who had migraine, 26.2% experienced aura. MWA was more common among females compared to males (32.6% vs 18.9%, P < .01) and among older children (OR: 2.50, 95% CI: 1.20-5.20; P < .01). Among those who experienced aura, visual aura was more common in females than males (66.7% vs 33.3%, P < .04). Family history of migraine was strongly related to MWA (P < .02): the odds of MWA were 2.46 times greater in children who had a family history of migraine. (OR: 2.46, 95% CI: 1.08-5.62; P < .03). CONCLUSIONS MWA is as common in children as in adults. Aura is more common in older children. Children who have MWA are more likely to have a family history of migraine.
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Affiliation(s)
- Jacob Genizi
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel.,Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Nathanel Zelnik
- Pediatric Neurology Unit, Carmel Medical Center, Haifa, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mitchell Schertz
- Child Development & Pediatric Neurology Service, Meuhedet - Northern Region, Haifa, Israel
| | - Isaac Srugo
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
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50
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Baykan B, Ertas M, Karlı N, Uluduz D, Uygunoglu U, Ekizoglu E, Kocasoy Orhan E, Saip S, Zarifoglu M, Siva A. Migraine incidence in 5 years: a population-based prospective longitudinal study in Turkey. J Headache Pain 2015; 16:103. [PMID: 26634568 PMCID: PMC4669335 DOI: 10.1186/s10194-015-0589-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/30/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The incidence of migraine has been investigated only in a few studies worldwide and it is not known in our country. We, therefore, aimed to estimate the migraine incidence in a previously accomplished population-based prevalence study sample of 5323 individuals in the year 2008. METHODS The former Turkish headache prevalence study has been completed as a nationwide, randomized, home-based study of face-to-face examination by physicians trained for headache diagnosis by using ICHD criteria. Five years after this study an optimized survey including 50 questions was performed to estimate the migraine incidence in migraine-free individuals in the previous study, with a 56.4 % responder rate. Two validation studies for this survey were performed prior and after the study each in 100 subjects by comparing the gold standard of expert diagnosis of headache, showing high rate of reliability (Crohnbach alpha: 0.911 and 0.706, respectively). RESULTS Migraine incidence was estimated as 2.38 % (2.98 % in women and 1.93 % in men) per year in 2563 migraine-free individuals; if the population at risk is defined as the group without any headaches, the migraine incidence decreased to 1.99 %. The chronic migraine (CM) incidence [without medication overuse (MOH)] was 0.066 % and that of MOH was 0.259 %. We found a significant burden of the disease on the occupational functionality as well as on social and family life, even in the early years of the migraine. The family history of headaches especially in the fathers could be useful to predict new cases of migraine, besides the well-known risk factor, diagnosis of depression, whereas income and education did not seem to relate to migraine onset. CONCLUSIONS Our study with a large population-based nation-wide sample, using ICHD-II criteria, with structured headache interviews as well as blinded re-validation of the questionnaire diagnoses showed a 2.38 % incidence rate of migraine in Turkey, higher than most of the other previous reports; a finding which could be related to genetic factors and also to the methodological differences in the study designs. Moreover the incidence of CM was found to be 0.066 %.
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Affiliation(s)
- Betul Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Mustafa Ertas
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Necdet Karlı
- Department of Neurology, School of Medicine, University of Uludag, Bursa, Turkey.
| | - Derya Uluduz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Ugur Uygunoglu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Esme Ekizoglu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Elif Kocasoy Orhan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Sabahattin Saip
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Mehmet Zarifoglu
- Department of Neurology, School of Medicine, University of Uludag, Bursa, Turkey.
| | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
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