Leisure activities in adolescents with headache

Screen time and pediatric headache: A scoping review of the literature

OBJECTIVE

The aim of this study was to summarize the evidence regarding screen use as a contributing factor in pediatric headache and migraine.

BACKGROUND

Screen exposure is often reported as a headache trigger, though there is no current consensus in terms of how screen type, duration, or frequency influences pediatric headache and the associated burden of disease.

METHODS

A systematic search in PubMed, Scopus, Cochrane Library, ProQuest Health and Medical Database, and Google Scholar was performed through November 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All English-language articles of pediatric patients aged ≤18 years evaluating screen use in relation to headache were included.

RESULTS

A total of 48 studies were included. Nearly all studies were cross-sectional and represented international samples. The strongest association between screen use and headache found was for duration of use, and computer use emerged as the most common device type related to headache. While there were mixed findings related to screen use and specific headache diagnosis, migraine appeared to confer a higher risk. Across studies, there were insufficient data to assess the impact of screen use on headache frequency or headache-related disability. Several studies demonstrated changes in screen use and headache patterns related to the COVID-19 pandemic and computer vision syndrome was commonly reported.

CONCLUSIONS

While there is preliminary evidence supporting possible associations between screen use and pediatric headache, there are several limitations in the present review including a lack of prospective and randomized controlled trials to better demonstrate causal relationships as well as methodological limitations with significant variability in how both headache and screen use are defined and measured. Future studies including real-time screen use and device monitoring are needed to better understand the influence of screen use behaviors on pediatric headache and to help further define best-use guidelines around these technologies.

Pediatric screen exposure and school related headache disability

BACKGROUND AND OBJECTIVES

Prolonged screen exposure is often cited as a trigger for pediatric headache. We present initial findings evaluating the association between adolescent screen use type, duration, and school disability.

METHODS

New patients aged 12-17 years presenting to a headache clinic were screened and surveyed regarding headache characteristics, behavioral habits, school attendance, and screen utilization.

RESULTS

99 adolescents (29 M, 70 F) with average age 14.8 years and average headache frequency of 17 days per month completed the survey. Patients missed an average of five full days and three partial days of school due to headaches over the 90 days prior to survey completion.No statistically significant correlation was found between type or duration of screen exposure and monthly headache frequency, school attendance, or school functioning. A small positive association was seen between increasing duration of computer use, total hours screen use, and school absenteeism. While most adolescents reported prolonged screen use (58.6%) and luminosity (64.6%) worsened headaches, no statistical difference was seen in average number of headache days per month.

CONCLUSIONS

Average monthly headache frequency in an adolescent population was not significantly correlated with type or duration of screen exposure. Further studies are needed to elucidate how screen utilization impacts school related headache disability.

The Effects of the COVID-19 Confinement on Screen Time, Headaches, Stress and Sleep Disorders among Adolescents: A Cross Sectional Study

BACKGROUND

Headache is a common symptom affecting children and adolescents. The medical literature over the last three decades reveals a variable prevalence and triggers in different countries, regions, circumstances and times. This study aims to assess the prevalence, frequency and quality of headaches in the Lebanese adolescent population under the COVID-19 confinement and study its triggers and relationship to screen time, self-reported anxiety, and sleep.

METHODS

A cross sectional design was used to collect two survey results by snowball distribution using social media targeting adolescents aged 15 to 17 years of age. The first survey included 13 questions with a single best answer about screen time, feeling anxious, sleep time, schedule and consistency, and headaches. The second survey included 3 questions about the quality of the headaches, anxiety and its triggers.

RESULTS

Among 433 responders to the first survey, the prevalence of headaches, especially pressure points and band-like pressure was higher than any previously reported among adolescents in the literature, reaching 93.4%. Screen time was also higher than any previous reports with 95.6% spending 9 hours or more on screen while 64% of adolescents spending at least 12 hours a day on screen. In addition, the majority (82%) don't have consistent sleep habits and 41.8% consider themselves anxious. School was considered the main source of stress by 82.8% of the responders. The frequency of headache correlated significantly with increased screen time, self-reported anxiety and inconsistent sleep habits.

CONCLUSIONS

Headaches among adolescents are associated with increased screen use, sleep disorders, and self-reported anxiety. It is one of the primary somatization symptoms in this group expressing their extreme stress under the current economic, political, and health crisis. The present trends are likely to have major long term implications on adolescents' health and academic achievements and should alarm educators and health officials to intervene in this situation.

The effect of computer use on the occurrence of migraine

Background/Aim. Risk factors concerning computer use-related migraine onsets are still unknown. The aim of this study was to determine the prevalence of headaches in computer users as well as the effects of computer use and behavior on the prediction of migraine presence. Methods. A cross-sectional study included 1,500 subjects from the general population who were given a questionnaire to assess the presence and type of headache and questions regarding computer-assisted behavior. All examinees were divided into two groups: the first group consisted of respondents who had a headache, and the second group consisted of subjects without a headache. Results. A total of 67.9% of the subjects had a headache, of which 23.9% had a migraine. Results of multinomial regression analysis showed that significant predictors of the migraine group, compared to the group without headache, were gender (female) and family anamnesis positive for migraine, as well as spending more time on the computer, making shorter and infrequent breaks in which physical activities were less included. Furthermore, members of the migraine group, compared with the group with other types of headaches, were younger and had family anamnesis, rarely made pauses during computer use, and their pauses were shorter. Conclusion. Improper and excessive computer use could be considered a risk factor for migraine occurrence, particularly in young people who have positive family anamnesis for migraine.

Cross-Sectional Study of Headache in Flemish Children and Adolescents

Background: Although headache is common in pediatrics, data for the Flemish population are missing. We explored headache-prevalence, and its association with communication-technology (CT) and physical activity (PA) in Flemish children and adolescents. Methods: A cross-sectional exploratory school-based questionnaire study was designed. Flemish boys and girls (5–18 years) completed a symptom-questionnaire. Primary outcomes: sociodemographic background, headache-prevalence, headache-characteristics, CT-use and PA characteristics (self-report). Secondary outcomes: associations between headache-characteristics, age, gender, and CT-use and PA-characteristics. Results: Four hundred twenty-four questionnaires were analysed: 5–7-years: n = 58; 8–11-years: n = 84; 12–15-years: n = 137; 16–18-years: n = 145. Fifty-five percent suffered from headache. Prevalence increased with age. More 16–18-year girls versus boys had headache. CT-use was the main headache-provocateur. Headache prevalence was significantly higher in a frequently physical active population. Conclusion: Our results suggest presence of headache in Flemish children and adolescents. PA-level associates with headache prevalence. However, children and adolescents with headache did not report more CT-use compared to controls.

Electronic Screen Exposure and Headache in Children

Headache represents the most common neurologic disorder in the general population including children and is increasingly being recognized as a major source of morbidity in youth related to missed school days and activities. Electronic screens are becoming increasingly important in the lives of preteens and teens. In this review, we discussed effects of electronic screens on primary headache in childhood to emphasize the importance of electronic screen exposure in children with headache. Using digital and social media can bring some benefits and risks for mental and physical health. Time spent on screen-based activities contributes to the chance of reporting general physical complaints, in particular, headache and backache during early adolescence. We suggest that all children with primary headache should be evaluated for abuse of electronic screens in neurology practice. We also think that restriction of electronic screen should be advised in children with migraine and tension type headache before initiation of pharmacotherapy. As online classes are a reality, use of electronic screen may be allowed for school age children up to 2 h/day with taking time away from digital media every 20 min for 20 sec. In conclusion, we would like to emphasize that limiting the time spent on the screen is important for the reduction of headache symptoms of children and adolescents.

Prevalence of primary headache disorders among information technology staff in China: the negative effects of computer use and other correlative factors

BACKGROUND

To date, there have been very few studies that have explored the relationship between headaches and computer use. The chief aim of this study is to investigate the prevalence of primary headache disorders among informational technology staff and identify the potential factors contributing to it.

METHODS

This is a cross-sectional study based on annual health checks of employees from the information technology industry. We identified 2216 information technology staff members from Beijing by stratified random sampling who met the inclusion criteria. All participants were initially required to have a physical examination, after which they complete a general situation questionnaire that included a headache screening question. Those who had suffered from headache within the previous year also completed the questionnaire developed by Lifting the Burden. The International Classification of Headache Disorders 3(ICHD-3) criteria was used for the diagnosis of headache.

RESULTS

A total of 2012 valid questionnaires (males, 1544 [76.7%]; females, 468 [23.3%]) were obtained from 2216 participants for a response rate of 90.8%. A total of 619 participants were diagnosed with primary headache, the one-year prevalence of which was 30.8%. Regarding the classification of the primary headache, 152 participants suffered from migraine, with a one-year prevalence of 7.6%; 440 and 27 suffered from tension-type headache and unclassified headaches, with one-year prevalences of 21.9 and 1.3%, respectively. Multivariate regression analysis showed that female gender was a risk factor for migraine and tension-type headache (OR 3.21[95% CI 2.28-4.53] and 1.88[95% CI 1.47-2.40], respectively). Age was also related to migraine and tension-type headache. The 41-50 age group had 2.02 times the probability of migraine, and the 31-40 age group had 1.89 times the probability of tension-type headaches compared to the 18-30 age group. Obesity and excessive computer use (more than 12 h per day) were also factors contributing to tension-type headache (OR: 2.61[95% CI 1.91-3.56] and 1.63[95% CI 1.18-2.25], respectively).

CONCLUSIONS

The one-year prevalence of primary headache in this population was 30.8%. The prevalence of tension-type headache in this population was higher than that in the general Chinese population. The occurrence of primary headache is correlated with many factors, among which excessive computer use significantly contributed to the risk of tension-type headache.

An ounce of discretion is worth a pound of wit--ergonomics is a healthy choice

OBJECTIVE

The objective of the study was to identify the occurrence and outcome of low back ache amongst computer users and their relation to age, gender, occupation and duration of computer use.

MATERIALS AND METHODS

A self reported questionnaire tailored from Occupational Health and Safety Act of the Ministry of Labor, Ontario, Canada was used.

RESULTS

416 participants 55.5% males and 45% females using computers for a minimum of five years with age range 22 to 59 years belonged to different occupational groups. Consecutive hours of computer work was found to be associated with work related backache or discomfort in 27.4% (n = 114) participants (16.1% male, 11.3% female). Frequent short breaks improved backache (p value <0.001) in 93 (22.4%) participants (13.2% male, 9.2% female). No significant relation was observed with the duration of computer usage or usage per day; between the two genders or occupational groups. Backache had no significance within age groups.

CONCLUSION

Our study identifies the occurrence of low back pain among those who are using computer for consecutive hours without breaks and the results suggest the need to create health awareness especially use of short breaks to minimize the risk and occurrence of low back pain. The result of this study can also be used to improve ergonomic design and standards.

Musculoskeletal symptoms and computer use among Finnish adolescents--pain intensity and inconvenience to everyday life: a cross-sectional study

Background

Musculoskeletal symptoms among adolescents are related to the time spent using a computer, but little is known about the seriousness of the symptoms or how much they affect everyday life. The purpose of the present study was to examine the intensity of musculoskeletal pain and level of inconvenience to everyday life, in relation to time spent using a computer.

Methods

In a survey, 436 school children (12 to 13 and 15 to 16 years of age), answered a questionnaire on musculoskeletal and computer-associated musculoskeletal symptoms in neck-shoulder, low back, head, eyes, hands, and fingers or wrists. Pain intensity (computer-associated symptoms) and inconvenience to everyday life (musculoskeletal symptoms) were measured using a visual analogue scale. Based on the frequency and intensity, three categories were formed to classify pain at each anatomic site: none, mild, and moderate/severe. The association with time spent using the computer was analyzed by multinomial logistic regression.

Results

Moderate/severe pain intensity was most often reported in the neck-shoulders (21%); head (20%); and eyes (14%); and moderate/severe inconvenience to everyday life was most often reported due to head (29%), neck-shoulders (21%), and low back (16%) pain. Compared with those using the computer less than 3.6 hours/week, computer use of ≥ 14 hours/week, was associated with moderate/severe increase in computer-associated musculoskeletal pain at all anatomic sites (odds ratio [OR] = 2.9-4.4), and moderate/severe inconvenience to everyday life due to low back (OR = 2.5) and head (OR = 2.0) pain.

Conclusions

Musculoskeletal symptoms causing moderate/severe pain and inconvenience to everyday life are common among adolescent computer users. Daily computer use of 2 hours or more increases the risk for pain at most anatomic sites.

The association between use of electronic media and prevalence of headache in adolescents: results from a population-based cross-sectional study

BACKGROUND

Use of electronic media, i.e. mobile phones, computers, television, game consoles or listening to music, is very common, especially amongst adolescents. There is currently a debate about whether frequent use of these media might have adverse effects on health, especially on headaches, which are among the most-reported health complaints in adolescents. The aim of the present study was to assess associations between frequent use of electronic media and the prevalence of different types of headache in adolescents.

METHODS

Data were derived from a population-based sample (n = 1,025, ages 13-17 years). Type of headache (i.e. migraine, tension-type headache, unclassifiable headache) was ascertained by standardized questionnaires for subjects reporting headache episodes at least once per month during the last six months. Duration of electronic media use was assessed during personal interviews. Associations were estimated with logistic regression models adjusted for age group, sex, family condition and socio-economic status.

RESULTS

Most of the adolescents used computers (85%), watched television (90%) or listened to music (90%) daily, otherwise only 23% of the participants used their mobile phones and only 25% played with game consoles on a daily basis. A statistically significant association between listening to music and any headache (odds ratio 1.8; 95% confidence interval 1.1-3.1 for 30 minutes per day, 2.1; 1.2-3.7 for 1 to 2 hours per day; 2.0; 1.2-3.5 for 3 hours and longer listening to music per day) was observed. When stratifying for type of headache, no statistically significant association was seen.

CONCLUSIONS

Apart from an association between listening to music on a daily basis and overall headache, no consistent associations between the use of electronic media and different types of headache were observed.

Computer-associated health complaints and sources of ergonomic instructions in computer-related issues among Finnish adolescents: a cross-sectional study

BACKGROUND

The use of computers has increased among adolescents, as have musculoskeletal symptoms. There is evidence that these symptoms can be reduced through an ergonomics approach and through education. The purpose of this study was to examine where adolescents had received ergonomic instructions related to computer use, and whether receiving these instructions was associated with a reduced prevalence of computer-associated health complaints.

METHODS

Mailed survey with nationally representative sample of 12 to 18-year-old Finns in 2001 (n = 7292, response rate 70%). In total, 6961 youths reported using a computer. We tested the associations of computer use time and received ergonomic instructions (predictor variables) with computer-associated health complaints (outcome variables) using logistic regression analysis.

RESULTS

To prevent computer-associated complaints, 61.2% reported having been instructed to arrange their desk/chair/screen in the right position, 71.5% to take rest breaks. The older age group (16-18 years) reported receiving instructions or being self-instructed more often than the 12- to 14-year-olds (p < 0.001). Among both age groups the sources of instructions included school (33.1%), family (28.6%), self (self-instructed) (12.5%), ICT-related (8.6%), friends (1.5%) and health professionals (0.8%). Receiving instructions was not related to lower prevalence of computer-associated health complaints.

CONCLUSIONS

This report shows that ergonomic instructions on how to prevent computer-related musculoskeletal problems fail to reach a substantial number of children. Furthermore, the reported sources of instructions vary greatly in terms of reliability.

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.

Long-term trends in the incidence of headache in Finnish schoolchildren

OBJECTIVE

To study changes over time in the incidence of migraine and frequent headache.

METHODS

A population-based study on migraine and other headaches in Finnish children starting school at age 7 years in the city of Turku was conducted in 1974, 1992, and 2002. The study design used in each study was virtually identical. The study population included 1927 children in 1974, 1436 children in 1992, and 1066 children in 2002. The corresponding response rates were 90%, 96%, and 81%.

RESULTS

An increasing trend in the incidence of migraine was found from 1974 to 2002 in both boys and girls. The incidence rates of migraine with aura increased from 5.2 per 1000 person-years in 1974 to 41.3 per 1000 person-years in 2002. The increase in the rates of migraine without aura was from 14.5 per 1000 person-years in 1974 to 91.9 in 2002. Similarly, a significant increase over time was seen in the incidence of frequent headache from 1974 to 2002 in both boys and girls.

CONCLUSIONS

The incidence of childhood migraine and frequent headache has substantially increased over the last 30 years. The increased incidence is alarming and reflects untoward changes in children's lifestyles. Additional studies are needed on causal associations with life changes.