One‐Year Incidence, Course, and Outcome Predictors of Frequent Headaches Among Early Adolescents

Cohort profile: The Youth and Mental Health Study (YAMHS) - a longitudinal study of the period from adolescence to adulthood

The aim of this article is to provide a detailed description of the Youth and Mental Health Study (YAMHS),a population-based, representative (cluster sampling), prospective cohort study that was conducted to investigate risk and resilience factors for mental health conditions, specifically depressive symptoms and disorders, from adolescence to adulthood. The baseline data were collected in 1998 (T1) in two counties in central Norway from 2464 adolescents (response rate 88.3%, mean age 13.7 years). The first follow-up was conducted in 1999 (T2) (n = 2432, response rate of 87.1%, mean age 14.9 years). A subgroup of individuals was assessed at T2 (n = 345) with clinical interviews, and this subgroup was reassessed in 2005 (T3) (n = 265, 70.1%, 20 years). The last follow-up (of participants assessed at T1 and T2) was conducted in 2012 (T4) (n = 1266, 51.9%, 27.2 years). Demographics, depressive symptoms, general psychopathology, suicidal ideation and attempts and psychological and somatic factors were recorded. Among adolescents of both sexes, psychosocial variables were correlated with and predicted depressive symptom severity. The strongest predictors were sex (female), the levels of depressive symptoms the preceding year, and the total number of stressful events. The association between stressful life events and depressive symptoms was moderated by physical activity, while the relationship between stressful events and coping style was mediated by depressive symptoms. The rate of use of specialised mental health services among the depressed was low. The lifetime prevalence of depressive disorders was 23% at 15 years, and the most common disorder was minor depression. Adolescents who attempted suicide were more often victims of violence and less resilient than were non-suicide attempters. The existing longitudinal data from the cohort will be further analysed. Follow-up data will be obtained from existing national registries by links created with individual identification numbers.

Long-term follow-up of a community sample of adolescents with frequent headaches

Background

Several outcome studies have reported on the short- and long-term effects of migraine in selected clinical samples of children and adolescents. However, current knowledge of the course, incidence, and outcome predictors of frequent headaches in early adolescents in community populations is limited, and little is known about the long-term effects. Headache remains untreated in most of these young people. Here we examined the course, incidence, and outcome predictors of frequent headaches (at least once a week) over the long term (14 years) using previously assessed data at the baseline and 1-year follow-up of early adolescents.

Methods

Out of an original sample of 2440 who participated in the first two assessments, a sample of 1266 participants (51.9% response rate) aged 26–28 years (mean = 27.2 years) completed an electronic questionnaire comprising questions about their headache frequency and duration at the long-term follow-up. These headache characteristics together with gender, age, parental divorce, number of friends, school absence, impairment of leisure-time activities and seeing friends, pain comorbidity, and emotional (in particular, depressive symptoms) and behavioral problems were analyzed.

Results

In these young people, 8.4% reported frequent headaches (at least once a week) at the extended follow-up, while 19% of the participants having such headaches at baseline again reported such levels with a negligible gender difference. Over the follow-up period, 7.4% had developed frequent headaches, and a higher percentage of females reported such headaches (11.3% in females, 1.5% in males). In a multivariate model, frequent headaches at the baseline, gender (worse prognosis in females), impairment of leisure-time activities and seeing friends, and higher level of depressive symptoms significantly predicted headache frequency at the long-term follow-up.

Conclusions

Our findings suggest that gender, greater social impairment, and comorbid depressive symptoms are important indicators for both the short- and long-term prognosis of frequent headaches in early adolescents in community populations.

Longitudinal study shows that depression in childhood is associated with a worse evolution of headaches in adolescence

AIM

The aim of this study was to examine the course of headache diagnosis, headache frequency, anxiety, comorbid depressive symptoms and school absenteeism in adolescents with migraine and tension-type headaches five years after baseline.

METHODS

We followed a group of 122 children with a mean age of 10.1 (±1.3) years, with headache from a paediatric migraine centre in Paris who had taken part in a previous study from September 2007 to June 2008. This five-year longitudinal study took place in January to June 2012. The measures that were used included demographic variables, headache diagnosis, headache data and a psychological assessment.

RESULTS

At the five-year point, about 22% of the children had become headache free, 34% had little to no disability, and 36% had a changed diagnosis. Moreover, a longer history of headache at baseline was associated with a worse evolution of headache at follow-up. Lastly, high depression scores, but not anxiety, were a predictor of more headache disability at follow-up.

CONCLUSION

High depression scores in childhood were a risk factor that was associated with persistence and worsening of headaches in adolescence. This suggests that mental health assessments should be carried out in paediatric headache pain clinics.

Long term outcome of childhood onset headache: A prospective community study

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.

A 3-Year Follow-Up of Headache Diagnoses and Symptoms in Swedish Schoolchildren

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.

Managing Chronic Pain in the Classroom: Development and Usability Testing of an eHealth Educational Intervention for Educators

Although chronic pain is relatively common in childhood, many teachers feel ill-prepared to work with students with chronic and recurrent pain in the classroom and would like to learn more about supporting these students. A web-based eHealth intervention designed to provide information about pain and pain management in the classroom was developed based on input from clinicians, and usability was tested using three groups of stakeholders (i.e., youth with chronic pain, parents of youth with chronic pain, and teachers). Preliminary testing indicated that the usability goals were met, with the majority of participants in all groups indicating that the website was easy to use and that they would either recommend it to teachers or use it themselves. Minor design and content changes were suggested and made, whereas major changes will be made in the future. Results provide encouraging preliminary support for the utility of eHealth interventions as knowledge translation and dissemination tools for educators.

Headache in school children: is the prevalence increasing?

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.

Relations between the characteristics and psychological comorbidities of chronic pruritus differ between men and women: women are more anxious than men

BACKGROUND

Although sex and gender are becoming more important in diagnostics and therapy, there is still little knowledge about sex-specific differences in chronic pruritus (CP).

OBJECTIVES

To compare, taking into consideration the characteristics of pruritus, sex-specific differences in psychological symptoms in patients with CP.

METHODS

Sociodemographic data, data on the clinical characteristics of the skin and CP were documented over a 1-year period in all patients attending the Competence Center Chronic Pruritus of the University Hospital Münster for the first time. All patients completed the Hospital Anxiety and Depression Scale. Student's t-tests for independent study groups and linear regression analyses were applied.

RESULTS

A total of 619 patients (278 men, 341 women) were included in the analysis. Women were more anxious than men, but were not more depressed. A linear regression analysis indicated that depression and anxiety scores in women were related to the average intensity of pruritus during the previous 4 weeks and to a more generalized pruritus at the beginning of CP; older age in women also correlated with the scores on the depression subscale. Interestingly, the associations were different in men: scores on the depression scale were associated with the diagnosis of CP pruritus with multiple scratch lesions.

CONCLUSIONS

There are sex-specific differences in the relationship between the psychological symptoms and clinical characteristics of CP; higher anxiety scores were achieved by women. Whether psychological symptoms can be reversed when CP and scratch lesions improve is an issue that needs further exploration.

Negative life events and migraine: a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline data

Background

Stress is a typical migraine trigger. However, the impact of negative life events on migraine activity is poorly studied. The aim of this study is to investigate the association between negative life events and migraine using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment.

Methods

ELSA-Brasil is a multicenter cohort study conducted in six Brazilian cities. Baseline assessment included validated questionnaires for headache classification and the occurrence of five pre-specified negative life events (financial hardship, hospitalization other than for childbirth, death of a close relative, robbery and end of a love relationship), focusing on a 12-month period before evaluation. We built crude and adjusted logistic regression models to study the association between the occurrences of negative life events and migraine diagnosis and activity.

Results

We included 4,409 individuals with migraine and 4,457 participants without headache (reference). After adjustment for age, sex, race, income and educational level, we found that the occurrence of a negative life event (Odds ratio = 1.31; 95% confidence interval = 1.19 – 1.45) was associated with migraine. However, after stratifying with subgroup analyses, only financial hardship (Odds ratio = 1.65; 95% confidence interval = 1.47 – 1.87) and hospitalization (Odds ratio = 1.47; 95% confidence interval = 1.25 – 1.72) were independently associated with migraine. Further adjustment for a current major depression episode and report of religious activity did not significantly change the results. Considering migraine frequency as (a) less than once per month, (b) once per month to once per week, or (c) more than once per week, financial hardship and hospitalization remained significantly associated with migraine in all episode frequency strata, with higher odds ratios for higher frequencies in adjusted models. We also observed a significant association between the death of a close relative and the highest migraine frequency stratum (Odds ratio = 1.38; 95% confidence interval = 1.09 – 1.75) in full-adjusted model.

Conclusions

The occurrence of financial hardship and hospitalization had a direct and independent association with migraine diagnosis and frequency. The death of a close relative was also independently associated with the highest migraine frequency stratum.

Psychological interventions for chronic pediatric pain: state of the art, current developments and open questions

SUMMARY Chronic pain, especially headache and recurrent abdominal pain, affects a sizable number of children and adolescents. In this selective overview, the need and rationale for psychological approaches to the treatment of chronic pediatric pain will be explored, and current developments and open questions will be addressed. Thus far, research has mostly focused on the efficacy of various psychological interventions such as relaxation, biofeedback and cognitive-behavioral interventions, specifically for headaches and recurrent abdominal pain. Yet, the differential efficacy of the various psychological interventions still awaits empirical evaluation. In fact, in the past decade, the focus of research has shifted more towards developing and evaluating treatment formats that target specific subgroups of patients, such as multimodal inpatient treatment programs for severely affected youth. On the other hand, much research has been devoted to self-help treatment formats such as internet-based intervention programs. Rather surprisingly, the role of parents in the treatment of chronic pediatric pain is far from being understood, which may be best accounted for by the fact that psychological interventions were mostly adapted from treatment programs in adults rather than being specifically developed for children and adolescents. Conclusions for clinical practice and research are outlined.

Judging the quality of evidence in reviews of prognostic factor research: adapting the GRADE framework

BACKGROUND

Prognosis research aims to identify factors associated with the course of health conditions. It is often challenging to judge the overall quality of research evidence in systematic reviews about prognosis due to the nature of the primary studies. Standards aimed at improving the quality of primary studies on the prognosis of health conditions have been created, but these standards are often not adequately followed causing confusion about how to judge the evidence.

METHODS

This article presents a proposed adaptation of Grading of Recommendations Assessment, Development and Evaluation (GRADE), which was developed to rate the quality of evidence in intervention research, to judge the quality of prognostic evidence.

RESULTS

We propose modifications to the GRADE framework for use in prognosis research along with illustrative examples from an ongoing systematic review in the pediatric pain literature. We propose six factors that can decrease the quality of evidence (phase of investigation, study limitations, inconsistency, indirectness, imprecision, publication bias) and two factors that can increase it (moderate or large effect size, exposure-response gradient).

CONCLUSIONS

We describe criteria for evaluating the potential impact of each of these factors on the quality of evidence when conducting a review including a narrative synthesis or a meta-analysis. These recommendations require further investigation and testing.

Reciprocal longitudinal associations between pain and depressive symptoms in adolescents

BACKGROUND

Elevated depressive symptoms are common in youth with chronic pain, and pain symptoms are frequent in adolescents with depressive disorders. While studies have identified concurrent associations between pain and depression over time in youth, it is unclear how change in one symptom impacts change in the other symptom.

METHODS

This three-time point 12-month longitudinal study examined reciprocal associations among pain and depression in a clinical sample of adolescents (12-18) diagnosed with chronic pain (n = 55) or a depressive disorder (n = 40). Mixed-effects multivariate models were used to test if changes over a preceding time interval predicted symptom severity at subsequent time points. Study group, age, sex, race, baseline pain intensity and baseline depressive symptoms were included as covariates.

RESULTS

Generalized estimating equations revealed that pain and depressive symptoms were significantly associated over time (β = 1.54; p < 0.001). As hypothesized, changes in pain were associated with subsequent depressive symptoms (β = 1.16; p < 0.001). Conversely, changes in depressive symptoms predicted subsequent pain (β = 0.026; p < 0.05), but with a weaker association. In the model predicting pain, an interaction between depressive symptoms and study group emerged (β = -0.02; p < 0.05), with change in depressive symptoms having the greatest impact on pain in the depressed sample.

CONCLUSIONS

Findings extend previous adult research to an adolescent sample showing changes in pain intensity are predictive of subsequent depressive symptoms. In comparison to adult data, changes in depressive symptoms had less impact on subsequent pain in youth. Future research can examine how targeting persistent pain may also aid the treatment of depressive symptoms in adolescents.

How robust is the evidence of an emerging or increasing female excess in physical morbidity between childhood and adolescence? Results of a systematic literature review and meta-analyses

For asthma and psychological morbidity, it is well established that higher prevalence among males in childhood is replaced by higher prevalence among females by adolescence. This review investigates whether there is evidence for a similar emerging female ‘excess’ in relation to a broad range of physical morbidity measures. Establishing whether this pattern is generalised or health outcome-specific will further understandings of the aetiology of gender differences in health. Databases (Medline; Embase; CINAHL; PsycINFO; ERIC) were searched for English language studies (published 1992–2010) presenting physical morbidity prevalence data for males and females, for at least two age-bands within the age-range 4–17 years. A three-stage screening process (initial sifting; detailed inspection; extraction of full papers), was followed by study quality appraisals. Of 11 245 identified studies, 41 met the inclusion criteria. Most (n = 31) presented self-report survey data (five longitudinal, 26 cross-sectional); 10 presented routinely collected data (GP/hospital statistics). Extracted data, supplemented by additional data obtained from authors of the included studies, were used to calculate odds ratios of a female excess, or female:male incident rate ratios as appropriate. To test whether these changed with age, the values were logged and regressed on age in random effects meta-regressions. These showed strongest evidence of an emerging/increasing female excess for self-reported measures of headache, abdominal pain, tiredness, migraine and self-assessed health. Type 1 diabetes and epilepsy, based on routinely collected data, did not show a significant emerging/increasing female excess. For most physical morbidity measures reviewed, the evidence broadly points towards an emerging/increasing female excess during the transition to adolescence, although results varied by morbidity measure and study design, and suggest that this may occur at a younger age than previously thought.

Sex-specific predictor analyses for the incidence of recurrent headaches in German schoolchildren

Objective: The aim of the present study was to identify psychosocial risk factors for the incidence of recurrent headache (HA) in children/adolescents (8–15 years).

Method: In 2003 (Wave 1) a representative, population-based sample of 8800 parents was mailed a questionnaire. Those who took part were asked to participate again one year later (Wave 2). Of the parents originally contacted, 47.3% participated in both surveys. Potential risk factors concerning the areas ‘school’ and ‘emotional and behavioural problems’ were collected in Wave 1. Binary logistic regression analyses were performed to assess their predictive value for HA in Wave 2.

Results: Univariable regression analyses showed that for boys and girls most of the predictor variables influenced the incidence of recurrent HA, but only to a very low extent. When all variables were assessed jointly in a multivariable model, these factors lost their predictive power for boys. For girls, ‘academic problems’ and ‘dysfunctional stress coping’ were shown to increase the chance for the incidence of recurrent HA.

Discussion: In contrast to previous findings, school-related factors and emotional and behavioural problems failed to predict HA in boys, and only two factors appeared relevant with regard to girls. This might be due to the strict unidirectional design, which focussed exclusively on the incidence of HA.

Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice

BACKGROUND

Medically unexplained physical symptoms, commonly referred to as functional somatic symptoms (FSS), are common in pediatric medical settings and associated with suffering, impairment, and medical help seeking. The association of pediatric FSS with anxiety and depressive symptoms and disorders across the life span is reviewed.

METHOD

Review and critique of controlled studies examining cross-sectional and longitudinal associations of FSS with anxiety and depressive symptoms and disorders in community-based and clinical samples of children and adolescents.

RESULTS

FSS are consistently associated cross-sectionally with anxiety and depressive symptoms and disorders in childhood and adolescence, and the likelihood of associated anxiety and depression increases with the number of reported FSS. The presence of one or more FSS early in life is associated with an increased likelihood of multiple FSS and anxiety and depressive symptoms and disorders later in life, and anxiety and depressive symptoms and disorders in childhood are associated with subsequent multiple FSS.

CONCLUSION

Strong associations between FSS, anxiety, and depression across the life span suggest the need to reconsider existing nosology and reconceptualize symptomatic relationships. Large, population-based longitudinal studies of FSS, anxiety, and depressive symptoms and disorders are needed to establish temporal relationships between the various symptoms and conditions.

Self-treatment of pain among adolescents in an urban community

Pain occurrence among adolescents, whether acute or chronic, persistent or intermittent, remains high, with potentially serious effects on quality of life, physical and emotional functioning, and psychosocial adjustment. The prevalence of pain in adolescents varies widely, and although discussed in the literature for more than two decades, data on adolescent knowledge and pain self-treatment is scarce. This descriptive-correlational study identified pain prevalence and intensity and pain self-treatment choices among adolescents in a diverse urban community. Almost 90% (n = 253) of high school students reported pain in the preceding 2 weeks and completed a series of study questionnaires (demographic data form, Brief Pain Inventory-Short Form, Adolescent Self-Treatment Survey). Respondents ranged in age from 14 to 19 years (mean 16) and were predominantly female (70%) and caucasian (75%). The sample was representative of all high school grades, and the majority (86%) reported participation in sports, dance, and physical activities. Mean pain scores ranged from 3.0 (current pain) to 6.5 (worst pain), with significantly higher scores among girls. A gender-related effect was also noted for pain interference in activities, mood, and sleep among the adolescent girls compared with the boys. Gender also predicted use of self-treatment methods, with girls more likely to use over-the-counter medications and nonpharmacologic therapies. Number of pain sites was also a strong predictor of use of self-treatment methods among adolescents. Knowledge of the pain experience during adolescence will help guide community-based nursing initiatives aimed at increasing awareness, promoting knowledge about pain and its treatment, and ensuring safety and positive outcomes related to self-treatment.

The Role of the Mental Health Practitioner in the Assessment and Treatment of Child and Adolescent Chronic Pain

Chronic and recurrent benign pain complaints are common among children and adolescents. Although many young persons with chronic pain adapt well, a small, but significant, proportion experience marked functional deficits. Pain can produce life disruptions, e.g. impeding activities and maturation, and interferes with family functioning. Conventional medically-based approaches have been inadequate in addressing chronic pain and its sequelae. Instead, effective management requires an interdisciplinary approach involving paediatricians and mental health practitioners working collaboratively to treat psychiatric comorbidities, enhance the patient's functional adaptation, restore the child or adolescent's maturational and social capabilities and reduce family disruptions.

Factors associated with internalizing or somatic symptoms in a cross-sectional study of school children in grades 1-10

BACKGROUND

School related factors that may contribute to children's subjective health have not been extensively studied. We assessed whether factors assumed to promote health and factors assumed to have adverse effects were associated with self-reported internalizing or somatic symptoms.

METHODS

In a cross-sectional study, 230 boys and 189 girls in grades 1-10 from five schools responded to the same set of questions. Proportional odds logistic regression was used to assess associations of school related factors with the prevalence of sadness, anxiety, stomach ache, and headache.

RESULTS

In multivariable analyses, perceived loneliness showed strong and positive associations with sadness (odds ratio, 1.94, 95% CI 1.42 to 2.64), anxiety (odds ratio, 1.78, 95% CI 1.31 to 2.42), and headache (odds ratio, 1.47, 95% CI 1.10 to 1.96), with consistently stronger associations for girls than boys. Among assumed health promoting factors, receiving necessary help from teachers was associated with lower prevalence of stomach ache in girls (odds ratio, 0.51, 95% CI 0.30 to 0.87).

CONCLUSIONS

These findings suggest that perceived loneliness may be strongly related to both internalizing and somatic symptoms among school children, and for girls, the associations of loneliness appear to be particularly strong.

Migraine in junior high-school students: A prospective 3-academic-year cohort study

Migraine is a common childhood illness with expected favorable outcome. A study of the long-term clinical course of childhood migraine will provide information of evolution of migraine. A cohort study for 3-academic-year was conducted in Thai junior high-school children from July 2005 to February 2008 to determine the clinical course of migraine. Two hundred and forty-eight students in four junior high schools diagnosed with migraine according to ICHD-II in July 2005 were recruited. Each student was serially evaluated twice yearly from 7th grade during each semester of the academic year until the second semester of 9th grade. Determination of the characteristics, severity, frequency, and treatment of headache were obtained by questionnaire and direct interview. At the final evaluation, clinical course of headache was categorized into seven patterns. Among enrolled students, 209 (84.3%) completed the study. Twenty-eight (13.5%) students had no recurrent headache while that of 153 (73.5%) improved. No improvement of migraine and worsened migraine were observed in four students (1.8%) and 24 students (11.2%), respectively. Spontaneous remission and avoidance of precipitating causes contributed to relief of migraine in the majority of the students. Stress-related daily school activities and inadequate rest were reported as common precipitating factors among students with non-improving or worsening outcome. Chronic daily headache and tension-type headache was observed in 6 and 30 students, respectively. This study confirms that clinical course of migraine in schoolchildren is benign. Frequency and intensity of headache can be reduced with reassurance and appropriate guidance. Early recognition and appropriate prevention of migraine attack will decrease the risk of chronic migraine and disease burden.

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.

Risk factors for headache in children

BACKGROUND

10% to 30% of all children worldwide suffer from headaches at least once a week, potentially constituting a serious health problem that may lead to impairment in multiple areas. Therefore, one aim of the epidemiological longitudinal study "Children, Adolescents, and Headache" (KiJuKo) is the study of potential risk factors for the development of recurrent headaches.

METHODS

In the first survey (2003), questionnaires were sent to 8800 households with a child between 7 and 14 years of age. Three further surveys followed, one each year from 2004 to 2006. A number of predictors having to do with family characteristics and leisure activities were identified on the basis of the first survey and were then studied in the second survey (n = 2952) with respect to their influence on the new occurrence of headaches.

RESULTS

The risk of developing recurrent headaches between the first and the second survey was elevated by a factor of approximately 1.8 for boys who experienced quarrels in the family more than once per week, and by a factor of 2.1 for boys who only "sometimes" had free time for themselves. The risk of developing recurrent headaches was 25% higher in girls whose parents' behavior towards the child positively or negatively reinforced the occurrence of headaches.

CONCLUSIONS

These findings are in accordance with those of other studies showing that, for boys, the frequency of quarreling in the family and the extent of leisure time are major factors in the development of recurrent headaches. For girls, the manner in which the parents respond to the child's headache seems to be important.

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.

Pediatric headache

PURPOSE OF REVIEW

Headaches occur frequently in the pediatric population and have a significant impact on both the patient and their family. Migraine, the most common headache disorder for which patients see a physician, still remains underdiagnosed and undertreated. Recent studies have revealed the increasing incidence of migraine and chronic migraine in the pediatric population.

RECENT FINDINGS

Limitations of the present diagnostic criteria for migraine are presented, and the proposed modifications to these criteria may assist you with early recognition and ultimate treatment. New acute and preventive migraine treatment data demonstrating statistically significant benefit for the primary endpoints will be reviewed in detail. The clinically relevant impact of migraine on the pediatric patient documented by the use of the Pediatric Migraine Disability Assessment and the Pediatric Quality of Life Inventory will be discussed.

SUMMARY

A comprehensive management approach blending the most current acute, preventive, and biobehavioral treatments will be reviewed. Further research, with novel study designs, in pediatric headaches is needed to help reveal additional pathophysiological mechanisms, improve diagnostic criteria, and advance optimal treatment. Prospective studies are needed to fully evaluate the efficacy of preventive management in this population and to establish whether early intervention might slow this disease progression.

The frequency, trajectories and predictors of adolescent recurrent pain: a population-based approach

Recurrent pains are a complex set of conditions that cause great discomfort and impairment in children and adults. The objectives of this study were to (a) describe the frequency of headache, stomachache, and backache in a representative Canadian adolescent sample and (b) determine whether a set of psychosocial factors, including background factors (i.e., sex, pubertal status, parent chronic pain), external events (i.e., injury, illness/hospitalization, stressful-life events), and emotional factors (i.e., anxiety/depression, self-esteem) were predictive of these types of recurrent pain. Statistics Canada's National Longitudinal Survey of Children and Youth was used to assess a cohort of 2488 10- to 11-year-old adolescents up to five times, every 2 years. Results showed that, across 12-19 years of age, weekly or more frequent rates ranged from 26.1%-31.8% for headache, 13.5-22.2% for stomachache, and 17.6-25.8% for backache. Chi-square tests indicated that girls had higher rates of pain than boys for all types of pain, at all time points. Structural equation modeling using latent growth curves showed that sex and anxiety/depression at age 10-11 years was predictive of the start- and end-point intercepts (i.e., trajectories that indicated high levels of pain across time) and/or slopes (i.e., trajectories of pain that increased over time) for all three types of pain. Although there were also other factors that predicted only certain pain types or certain trajectory types, overall the results of this study suggest that adolescent recurrent pain is very common and that psychosocial factors can predict trajectories of recurrent pain over time across adolescence.

Headaches

PURPOSE OF REVIEW

Headaches and migraine occur frequently in children and adolescents and may have a significant impact on the child's and parents' lives. Recent advances in diagnosis, epidemiology, and treatment have improved the outcomes of children with headaches. This review summarizes some of these findings.

RECENT FINDINGS

Recent studies have revealed the increasing incidence of migraine and chronic migraine in the pediatric and adolescent age groups. These studies have also begun to identify comorbidities that may affect the impact over a lifetime. Limitations of the diagnosis of migraine have restricted some of these findings, but modifications to the criteria may assist with early recognition. Proper evaluation and treatment, including acute, preventive, and biobehavioral therapies, may need to be incorporated for optimal outcomes. Long-term outcomes may be determined by the underlying pathophysiology as well as early effective management.

SUMMARY

Migraine in children is increasingly being recognized as a problem. Early, effective treatment is available and may result in long-term benefit and prevent disease progression. Further research into childhood headaches should help reveal additional pathophysiological mechanisms and treatment options.

Repeated measures of recent headache, neck and upper back pain in Australian adolescents

The epidemiological and clinical literature identifies strong associations between adult headache, cervical and thoracic spine dysfunction and spinal posture. This paper reports on the prevalence and incidence of headache, neck and upper back pain which occurred in the previous week, in urban Australians aged 13-17 years. Commencing in 1999, we followed a cohort of South Australian students through 5 years of secondary schooling. Of our commencing cohort of students, 132 (30%) provided data on bodily pain every year. For both girls and boys, there was a significantly decreasing prevalence of headache over the study period, while neck pain and upper back pain increased. There was a significantly increasing trend over time for boys with upper back pain. Twenty percent of girls and boys consistently reported headache, neck pain or upper back pain over 5 years. The progression of early adolescent headaches to mid-adolescent neck and upper back pain potentially reflects the adolescents' biomechanical responses to intrinsic and extrinsic imposts. This requires further investigation to understand the causes of adolescent headache, neck and upper thoracic pain.