Outcome of Headache Frequency in Adolescence

Child-Patient Perspective on Results After Correction of Sagittal Synostosis and the Difference Between Child-Patient and Parent's Perspectives

OBJECTIVE

This study assesses the level of child-patient satisfaction with the surgical result after scaphocephaly correction and the difference between child-patient and parents' perspectives.

METHODS

A questionnaire was sent out to children between 6 and 18 years old with isolated sagittal synostosis, who had undergone either a frontobiparietal remodeling or extended strip craniotomy, and separately to their parents.

RESULTS

The questionnaire was completed by 96 patients, 81.2% of the patients considered their head to be similar or slightly different from others. Despite the majority being satisfied with the outcome, 33% would change the shape of their head if they could. Patients who underwent extended strip craniotomy wanted to change the back of their head more often ( P = 0.002), whereas patients who underwent frontobiparietal remodeling wanted to change their forehead ( P = 0.005). The patients' own perspective on head shape was independent of the cephalic index (CI). However, patients with a relatively narrow CI received more remarks from others about their heads ( P = 0.038). Parent and child agreement was 49.7% on average. Differences between child-patients and parents were found in reporting adaptive behavior.

CONCLUSION

The majority of patients were satisfied with the outcome of their intervention. The child's perspective seems to be a valuable addition to evaluate sagittal synostosis surgery as it is independent of the CI and differentiates between different surgical techniques. In addition, the patient's perspective is comparable to the parent's perspective, but gives more details on adaptive behavior.

Health-related Quality of Life in Children and Adolescents With Sagittal Synostosis

BACKGROUND

This study evaluated the health-related quality of life (HR-QoL) in patients with sagittal synostosis (SS), and the influence of frequent headaches and surgical techniques on the HR-QoL.

METHOD

Patients with SS aged 8 to 18 years were invited to participate between June 2016 and February 2017. The Child Health Questionnaire was used to assess the HR-QoL. A detailed questionnaire was used to assess the severity of headache symptoms. The control group consisted of 353 school children aged 5 to 14 years.

RESULTS

In all, 95 parents of patients with SS were invited to participate, of whom 68 (71.6%) parents completed the CHQ-PF50. The mean age of the participating patients was 12.4 years (10.8 to 14.2). The Psychosocial- and Physical summary of the patients with SS was similar to the general population. In the distinct CHQ scales, "Family cohesion" ( P =0.02) was higher, and "Mental health" ( P =0.05) was lower compared with the general population. The type and timing of surgery did not affect the HR-QoL. Thirty-two patients (47.1%) reported having headache complaints at least once a month. The CHQ scores of SS patients with frequent headaches had a significantly lower score of mild to large effect than those without headaches.

CONCLUSION

Patients with SS have a slightly lower to similar HR-QoL compared with the general population. In all, 47.1% of SS patients have frequent headaches, resulting in lower average HR-QoL. The type and timing of surgery did not affect the results. Clinicians should be aware of lower HR-QoL in some subgroups of patients with SS.

Remission of chronic headache: Rates, potential predictors and the role of medication, follow-up results of the German Headache Consortium (GHC) Study

Objectives To estimate remission rates of chronic headache (CH), focusing on potential predictors of headache remission and medication. Methods We used data from the longitudinal population-based German Headache Consortium (GHC) Study (n = 9,944, 18-65 years). Validated questionnaires were used at baseline (t₀, 2003-2007, response rate: 55.2%), first follow-up after 1.87 ± 0.39 years (t₁, 37.2%) and second follow-up after 3.26 ± 0.60 years (t₂, 38.8%) to assess headache type and frequency, use of analgesics and anti-migraine drugs, medication overuse, education, BMI, smoking and alcohol consumption. CH was defined as ≥ 15 headache days/month at t₀ over three months. Outcomes were: CH remission (<15 headache days/month at both follow-ups), CH persistence (≥ 15 headache days/month at both follow-ups); all others were considered as partially remitted. To estimate predictors of remission, univariate and multiple logistic regression were calculated. Results At baseline, 255 (2.6%) participants were identified with CH. Of these, 158 (62.0%) participants responded at both follow-ups. Remission was observed in 58.2% of participants, partial remission in 17.7% and persistence in 24.1%. Remission was associated with female sex (adjusted odds ratio: 3.10, 95% confidence interval: 1.06-9.08) and no medication overuse (4.16, 1.45-11.94) compared to participants with persistent CH; participants with higher headache frequency at t₀ were less likely to remit (0.90, 0.84-0.97). Medication, age, education, BMI, smoking and drinking showed no effects on remission. Similar results were observed for partial remission. Conclusion The majority of CH participants remitted from CH. Female sex, no overuse of pain medication and lower headache frequency were associated with remission.

Adolescent Disc Degeneration - No Headache Association

The objective of the study was to determine whether adolescents with headache have more disc degeneration in the cervical spine than headache-free controls. This study is part of a population-based follow-up study of adolescents with and without headache. At the age of 17 years, adolescents with headache at least three times a month ( N = 47) and adolescents with no headache ( N = 22) participated in a magnetic resonance imaging (MRI) study of the cervical spine. Of the 47 headache sufferers, 17 also had weekly neck pain and 30 had neck pain less than once a month. MRI scans were interpreted independently by three neuroradiologists. Disc degeneration was found in 67% of participants, with no difference between adolescents with and without headache. Most of the degenerative changes were located in the lower cervical spine. In adolescence, mild degenerative changes of the cervical spine are surprisingly common but do not contribute to headache.

Characteristics of Neck Pain Associated With Adolescent Headache

The objective of the study was to find out what kind of neck pain (NP) is associated with headache (HA) and with various headache variables: frequency, type, intensity, disturbance, and relief with analgesics. A population-based sample of 12-year-olds with and without HA ( n = 304) was followed for 4 years. At the age of 16 years, NP was evaluated on the basis of self-reported symptoms and a thorough physical examination of the neck region. Both self-reported and measured NP were associated with HA variables. Co-occurrent NP was found in adolescents with migraine as often as in those with tension-type HA. Especially, muscle pain and intensive, frequent NP were associated with disturbing HA unresponsive to analgesics. The study indicates that concomitant NP should be considered in adolescent HA sufferers, and a thorough cervical and muscle evaluation is recommended when planning the treatment of HA.

Cognitive processing styles of children and adolescents with headache and back pain: a longitudinal epidemiological study

BACKGROUND

Previous research has shown positive relationships between dysfunctional cognitive styles and different aspects of pain (eg, pain frequency). One goal of our longitudinal study was to investigate potential risk factors for the incidence of headache (HA) and back pain (BP).

METHODS

In the first wave (2003), questionnaires were sent to 6,400 children between the ages of 9 and 14 years. Those who answered in wave 1 were contacted again every year (four survey waves in total: 2003-2006). The data presented are based on the children's self-reports in the second wave (2004) and third wave (2005). Potential risk factors (dysfunctional stress coping, pain catastrophizing, anxiety sensitivity, and somatosensory amplification) were collected in wave 2. Binary logistic regression analyses - for boys and girls - were performed to assess the predictive value of the risk factors for HA and BP in wave 3.

RESULTS

In the comprehensive model, none of the examined variables predicted the incidence of HA. Anxiety sensitivity increased the risk that boys would report BP after 1 year by 50% and dysfunctional stress coping increased the risk by 40%. For girls, somatosensory amplification increased the risk of the incidence of BP 1 year later by 80%, whereas pain catastrophizing reduced the risk by 50%.

CONCLUSION

In this incidence sample, the amount of variance explained by the psychological variables investigated was very small. Integrating this result with existing findings from cross-sectional studies suggests that dysfunctional cognitive processing styles may develop more as a consequence or a concomitant feature of BP or HA, but play a less important role in its initial development.

Adolescent cervical disc degeneration in MRI does not predict adult headache or neck pain: A 5-year follow-up of adolescents with and without headache

AIM

The impact of early degenerative changes of the cervical spine on pain in adulthood is unknown. The objective was to determine whether degeneration in adolescence predicts headache or neck pain in young adulthood.

METHODS

As part of a follow-up of schoolchildren with and without headache, 17-year-old adolescents with headache at least three times a month (N = 47) and adolescents with no headache (N = 22) participated in a magnetic resonance imaging (MRI) study of the cervical spine. The same adolescents were re-examined by phone interview at the age of 22 years (N = 60/69, 87%).

RESULTS

Mild disc degeneration at the age of 17 years was common, but was not associated with either frequent or intensive headache or neck pain at the age of 22 years. Conclusion: Mild degenerative changes of the cervical spine in 17-year-old adolescents cannot be regarded as a cause of future headache or neck pain.

Neck flexor muscle fatigue in adolescents with headache - An electromyographic study

BACKGROUND

Muscular disorders of the neck region may be of importance for the etiology of tension-type headache. However, in adolescents, there are no data on the association between neck muscle fatigue and headache.

AIM

To study differences in fatigue characteristics of the neck flexor muscles in adolescents with and without headache.

METHODS

A population-based sample of 17-year-old adolescents with migraine-type headache (N=30), tension-type headache (N=29) and healthy controls without headache (N=30) was examined. Surface EMG data were recorded from the sternocleidomastoid (SCM) muscles bilaterally during an isometric neck flexor endurance test. The spectral median frequency (MF) change during the total endurance time (TMF) and the initial time of 30s (IMF) was calculated. The intensity of discomfort in the neck area was assessed with the visual analogue scale (VAS).

RESULTS

The rate of decline in TMF of both SCM muscles was significantly increased in the tension-type headache group compared with controls (right SCM, P=0.030, OR 2.0, 95% 1.2-3.7; left SCM, P=0.009, OR 2.5, 95% 1.4-4.9), while no significant differences were found between controls and subjects with migraine. The rate of decline in IMF, the total endurance time (P=0.050), and VAS did not differ significantly among the study groups.

CONCLUSIONS

This preliminary finding shows that increased neck flexor muscle fatigue in adolescents seems to be associated with tension-type headache.

Epidemiological-based childhood headache natural history study: After an interval of six years

Headache is a common problem among adolescents, and variations can be observed in headache types and characteristics. The present study aimed to reach 5562 Turkish children who were investigated six years previously in a school-based childhood headache project, and to evaluate their current headache status. Investigators interviewed the available students with structured questionnaires. New and old data were matched and analyzed. The present study included 1155 adolescents (mean age 15.2 ± 1.1 years), with 582 boys (50.4%) and 573 girls (49.6%). The prevalence of headache was 78.7% (tension-type headache [TTH] 57.5%, migraine 18.6%, unspecified 2.6%). The prevalence of headache was 45.2% six years previously. In the intervening six years, headache prevalence increased and the headache types changed significantly (Kappa: 0.04, p < .01). The most important variation during this time was the significant increase in TTH. Analgesic use was determined in 70.2% of adolescents with headache, with this ratio being higher in migraineurs. In conclusion, there were an increase in headache prevalence and a significant change in headache types over the previous six years. It can also be suggested that new country-based management strategies are required.

Prevalence and incidence of headache in adolescent Finnish twins

OBJECTIVES

The study aim was to determinate changes in prevalence and incidence rates of headache among adolescent Finnish twins.

METHODS

Questionnaire data were collected during 1994-1998 from a nationwide sample of Finnish families of 11-year-old twins who were born between 1983 and 1987 (n = 6262) and again at ages of 14 and 17.

RESULTS

During follow-up, the prevalence of regular headache (ie, at least once a month = RHA) increased from 59% at age 11 to 65% at age 14 and decreased to 63% at age 17. Among boys the prevalence of RHA increased significantly from 59% at age 11 to 62% at age 14 decreasing to 52% at age 17. Among girls the prevalence rates increased significantly between ages of 11 and 14 from 60% to 68% up to 74% at age 17. The prevalence of weekly headache increased in girls between ages of 11 and 14 from 16% to 25%. Incidence of RHA (at least once a month) decreased from 47% at age 14 to 44% at age 17 in girls and from 44% at age 14 to 30% at age 17 in boys.

CONCLUSIONS

RHA is more common in girls than boys during puberty, while the incidence of RHA declined especially in boys during same age period.

One-year course of paediatric headache in children and adolescents aged 8-15 years

The aims of the present study were the assessment of headache (HA) prevalence in German children and adolescents in the second year of a 4-year longitudinal study and the analysis of headache status change from year 1 to year 2. The original sample consisted of 8800 households with a child aged 7-14 years. A total of 4159 households responded in both year 1 and year 2, yielding 3984 valid parent questionnaires. Data regarding various aspects of the child's HA history and general health were gathered via mailed questionnaires from the parents. Of the households returning valid parent questionnaires at survey 2, 48.9% reported their child to have experienced headaches during the previous 6 months (53% at survey 1). Weekly HA was reported for 6.5% of the children, monthly or less frequent HA for 16.5% and 25.9%, respectively. With regard to headache diagnosis, 55.0% of the children and adolescents with HA experienced tension-type HA (TTH) and 11.3% migraine with or without aura (M). For more than half of the children and adolescents with HA (57.0%) the frequency of head pain remained stable over the period of 1 year (i.e. same frequency category in years 1 and 2). Improved and worsened HA status regarding frequency of occurrence was found in 22.3% and 20.7% of the subjects, respectively. Thus, there was no definite trend towards an increase of HA episodes over the course of 1 year regarding the individual child or adolescent. The most stable type of HA was TTH.

Force production and EMG activity of neck muscles in adolescent headache

PURPOSE

This study compared the maximal force, EMG/force ratio and co-activation characteristics of the neck-shoulder muscles between 30 adolescents with migraine-type headache, 29 with tension-type headache, and 30 headache-free controls.

METHOD

Force was measured with surface electromyography (EMG) from the cervical erector spinae (CES), the sternocleidomastoid (SCM) and trapezius muscles during the maximal isometric neck flexion, neck extension and shoulder flexion.

RESULTS

Girls with migraine-type headache had higher EMG/force ratios between the EMG of the left agonist SCM muscle and the corresponding maximal neck flexion (p = 0.030) and neck rotation force to the right side (p = 0.024) than the girls with tension-type headache. Migrainous girls had more co-activation of right antagonist CES muscle during maximal neck flexion force than the girls without headache (p = 0.015). Neck force production showed no significant differences between girls. Girls with tension-type headache displayed lower left shoulder flexion force than girls with migraine-type headache (p = 0.005) or with no headache (p = 0.005). In boys, no significant differences were observed.

CONCLUSIONS

Girls with tension-type headache and migraine-type headache have differences in neuromuscular function in the neck-shoulder muscles. The data amplify our knowledge of the neck-shoulder muscle dysfunction in adolescent headache, and may encourage the use of specific rehabilitation methods in the management of different types of headache.

Are Signs of Temporomandibular Disorders Stable and Predictable in Adolescents With Headache?

The aim of the present study was to study changes in signs and symptoms of temporomandibular disorders (TMD) and factors predicting TMD signs in adolescents with and without headache. A population-based sample ( n = 212) of 13-year-olds with and without headache was re-examined at the age of 16. The study included a questionnaire, face-to-face interview and somatic examination. In addition, a neurological examination, a muscle evaluation and a stomatognathic examination were performed. Significant changes were seen in TMD signs during the follow-up, but TMD signs at the end of the follow-up could not be predicted by baseline headache, sleeping difficulties, depression or muscle pain. TMD signs at the age of 16 were associated with female gender and muscle pain. We conclude that considerable changes in TMD signs occur in the follow-up of adolescents with and without headache. Headache-related TMD are not predictable in adolescents with and without headache.

The comorbidity of headache with other pain syndromes

In this article, we consider the possible reasons and supporting evidence for the comorbidity of chronic pain conditions. To simplify the discussion, we primarily focus on the epidemiology of headache with other pain conditions, dividing studies into those based on children or adolescents and those based on adults. We consider exogenous and endogenous factors, and methodological challenges, in understanding whether and how 2 pain conditions may be related.