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Choe R, Sim YF, Hong CHL, Mohideen S, Nadarajan R, Yap F, Shek LPC, Hsu CYS, Broekman BFP, Ferreira JN. Internalizing problems are associated with oral health-related quality of life in early childhood: Outcomes from an Asian multi-ethnic prospective birth cohort. PLoS One 2021; 16:e0256163. [PMID: 34383864 PMCID: PMC8360536 DOI: 10.1371/journal.pone.0256163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Oral health status ideally warrants for a holistic biopsychosocial approach to health and wellness. Little is known about the impact of behavioral problems on oral health-related quality of life (OHRQoL) in children due to the paucity of studies in early childhood, particularly in Asian multi-ethnic populations. This study evaluated the relationship between early child's socioemotional factors and OHRQoL, as well as its association with orofacial pain (OFP) and early childhood caries (ECC) in the Asian GUSTO birth cohort. Mother-child dyads were postnatally assessed at 3 time points. The Child Behavior Checklist (CBCL) was used to assess the child's socioemotional and behavioral problems at age 4-4.5 years together with other validated questionnaires to evaluate maternal anxiety and depression. ECC detection was performed at age 5, and OHRQoL (primary) and OFP (secondary) outcomes were assessed at age 6 from a total of 555 mother-child dyads. After a univariate regression analysis was performed to identify potential predictors and confounders, a multivariate regression model was run with predisposing factors (CBCL internalization and externalization problems, OFP, ECC) and adjusted for confounders (maternal psychosocial states, maternal education) to determine associations with OHRQoL. Results showed an association between CBCL internalization scores and poorer OHRQoL (RR = 1.03, p = 0.033, 95% CI 1.01 to 1.05), although the limited risk ratio may not have a practical applicability in psychosocially healthy children, alike the majority of those evaluated in this cohort. The average OHRQoL overall score among children with OFP was 2.39 times more than those without OFP (OR = 2.39, p < 0.001, 95% CI 2.00 to 2.86). Thus, in early childhood, OFP, and to lesser extent internalizing behaviors, may negatively impact OHRQoL. This study therefore highlights the complex relationship between OHRQoL and its predisposing socioemotional and somatic pain factors, and demands further investigations in clinically relevant populations.
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Affiliation(s)
- Ruth Choe
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Yu Fan Sim
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | | | - Sameema Mohideen
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Ranjani Nadarajan
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Fabian Yap
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Lynette P.-C. Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Birit F. P. Broekman
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
- OLVG and Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Joao N. Ferreira
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Faculty of Dentistry, Exocrine Gland Biology and Regeneration Research Group, Department of Research Affairs, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
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Abstract
Mind-body therapies are popular and are ranked among the top 10 complementary and integrative medicine practices reportedly used by adults and children in the 2007-2012 National Health Interview Survey. A growing body of evidence supports the effectiveness and safety of mind-body therapies in pediatrics. This clinical report outlines popular mind-body therapies for children and youth and examines the best-available evidence for a variety of mind-body therapies and practices, including biofeedback, clinical hypnosis, guided imagery, meditation, and yoga. The report is intended to help health care professionals guide their patients to nonpharmacologic approaches to improve concentration, help decrease pain, control discomfort, or ease anxiety.
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Headache symptoms consistent with migraine and tension-type headaches in children with anxiety disorders. J Anxiety Disord 2016; 40:67-74. [PMID: 27124732 DOI: 10.1016/j.janxdis.2016.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To examine the incidence of headache symptoms consistent with migraine and tension-type headache (TTH) in children with anxiety disorders. METHOD Parents of children with anxiety disorders (n=27) and children without anxiety disorders (n=36) completed a headache questionnaire based on the International Classification of Headache Disorders (2nd edition) criteria. RESULTS Children with anxiety disorders had a higher incidence of headache symptoms consistent with migraine and TTH compared to children without anxiety disorders. Girls with anxiety disorders and children with separation anxiety disorder had a higher incidence of headaches compared to girls without anxiety disorders and children with other anxiety disorders respectively. Children with anxiety disorders and headaches had higher self-reported anxiety symptom severity compared to children with anxiety disorders without headaches and children without anxiety disorders. CONCLUSION Findings highlight an overlap in anxiety and headaches in children and warrant further research on factors that contribute to the etiology and maintenance of these co-occurring problems.
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Law EF, Beals-Erickson SE, Noel M, Claar R, Palermo TM. Pilot Randomized Controlled Trial of Internet-Delivered Cognitive-Behavioral Treatment for Pediatric Headache. Headache 2015; 55:1410-25. [PMID: 26316194 DOI: 10.1111/head.12635] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility and preliminary effectiveness of an Internet-delivered cognitive-behavioral therapy (CBT) intervention for adolescents with chronic headache. BACKGROUND Headache is among the most common pain complaints of childhood. Cognitive-behavioral interventions are efficacious for improving pain among youth with headache. However, many youth do not receive psychological treatment for headache due to poor access, which has led to consideration of alternative delivery modalities such as the Internet. METHODS We used a parallel arm randomized controlled trial design to evaluate the feasibility and preliminary effectiveness of an Internet-delivered family-based CBT intervention, Web-based management of adolescent pain. Adolescents were eligible for the trial if they were a new patient being evaluated in a specialized headache clinic, between 11 and 17 years of age, and had recurrent headache for 3 months or more as diagnosed by a pediatric neurologist. Eighty-three youths were enrolled in the trial. An online random number generator was used to randomly assign participants to receive Internet CBT adjunctive to specialized headache treatment (n = 44) or specialized headache treatment alone (n = 39). The primary treatment outcome was headache days. RESULTS Youth and parents in the Internet CBT group demonstrated high levels of engagement with the web program and reported satisfaction with the intervention. Multilevel modelling (MLM) was used to conduct hypothesis testing for continuous outcomes. For our primary treatment outcome of headache days, adolescents reported a statistically significant reduction in headache days from baseline to post-treatment and baseline to 3-month follow-up in both treatment conditions (main effect for time F(2, 136) = 19.70, P < .001). However, there was no statistically significant difference between the Internet CBT group and the specialized headache treatment group at post-treatment or follow-up (group × time interaction F(2, 134) = 0.94, P = .395). For our secondary treatment outcomes, findings from MLM showed that adolescents in both groups demonstrated statistically significant improvement headache pain intensity, activity limitations, depressive symptoms, and parent protective behaviors from baseline to post-treatment and these gains were maintained at 3-month follow-up. Adolescent anxiety symptoms and sleep did not change during the study period for either group. There were no statistically significant group differences on any secondary outcomes at post-treatment or follow-up (P > .05 for all outcomes). No adverse events were reported. CONCLUSION Although adjunctive Internet CBT did not lead to additional benefit in this population, future research should evaluate whether it is an effective intervention for adolescents with headache who are unable to access specialized headache treatment.
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Affiliation(s)
- Emily F Law
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA
| | - Sarah E Beals-Erickson
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA
| | - Melanie Noel
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA
| | - Robyn Claar
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School and Boston Children's Hospital, Boston, USA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA
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Soee ABL, Skov L, Skovgaard LT, Thomsen LL. Headache in children: Effectiveness of multidisciplinary treatment in a tertiary paediatric headache clinic. Cephalalgia 2013; 33:1218-28. [DOI: 10.1177/0333102413490349] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim The aim of this article is to evaluate the effectiveness of a specific multidisciplinary treatment programme for children with headache and to describe the concept and settings of the Children’s Headache Clinic in Denmark. Method All new patients were included and evaluations were conducted after six and 12 months. Pharmacological and non-pharmacological treatments were offered by a team of specialists (physicians, headache nurses, a physiotherapist and a psychologist). Patients The subjects comprised 169 children (mean age 11.7 (range 4–17), 91 females, 78 males), 39% of whom suffered from chronic headache (≥15 days/month). All children were diagnosed according to the International Classification of Headache Disorders, second edition; 20% had migraine, 34% tension-type headache, 27% mixed headache, 4% medication-overuse headache, and 15% were diagnosed with other types of headaches. Results Fifty per cent of the children had an improvement in headache frequency above 50% at six months. By the use of repeated measurement analysis, we found a significant decrease in headache frequency in all of the six headache groups, whereas the increase in quality of life (PedsQL™ 4.0) was significant for the group as a whole. Conclusion Though preliminary, the results show a good outcome for multidisciplinary treatment programmes for children who suffer from frequent or chronic headache.
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Affiliation(s)
- Ann-Britt L Soee
- Department of Paediatrics, Children’s Headache Clinic, Copenhagen University Hospital Herlev, Denmark
| | - Liselotte Skov
- Department of Paediatrics, Children’s Headache Clinic, Copenhagen University Hospital Herlev, Denmark
| | | | - Lise L Thomsen
- Department of Neuropediatrics, Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Denmark
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Soee ABL, Skov L, Kreiner S, Tornoe B, Thomsen LL. Pain sensitivity and pericranial tenderness in children with tension-type headache: a controlled study. J Pain Res 2013; 6:425-34. [PMID: 23785242 PMCID: PMC3682848 DOI: 10.2147/jpr.s42869] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare tenderness and pain sensitivity in children (aged 7–17 years) with tension-type headache (TTH) and healthy controls using total tenderness score (TTS), pressure pain threshold (PPT), and pain perceived at suprapressure pain threshold (supraPPT). Patients and methods Twenty-three children with frequent episodic TTH, 36 with chronic TTH, and 57 healthy controls were included. TTS was measured bilaterally at seven pericranial myofascial structures. PPT and supraPPT were assessed in the finger, m. temporalis, and m. trapezius by a Somedic® algometer. SupraPPT was defined as the pain perceived at a stimulus calculated as the individual site-specific PPT + 50%. Statistics The effect of group, sex, age, headache frequency, intensity, and years on TTS, PPT, and supraPPT was analyzed by general linear models. Confirmatory factor analysis was analyzed for mutual relations between measurements. Results and conclusion Tenderness increased uniformly in both frequent episodic TTH (median 14; interquartile range [IQR] 10–18; P < 0.001) and chronic TTH (median 13; IQR 9–20; P < 0.001) compared to controls (median 5, IQR 3–11). However, the children with frequent episodic TTH and chronic TTH did not show significantly increased sensitivity when measured by PPT or supraPPT. Factor analysis confirmed that the site-specific measurements depended on general latent variables. Consequently, the PPT and supraPPT tests can be assumed to measure central pain-processing levels.
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Affiliation(s)
- Ann-Britt L Soee
- Department of Paediatrics, Children's Headache Clinic, Copenhagen University Hospital Herlev, Copenhagen, Denmark
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Soee ABL, Thomsen LL, Kreiner S, Tornoe B, Skov L. Altered pain perception in children with chronic tension-type headache: is this a sign of central sensitisation? Cephalalgia 2013; 33:454-62. [PMID: 23439572 DOI: 10.1177/0333102413476371] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The aim of this article is to investigate if children (7-17 years) with frequent episodic tension-type headache (FETTH) or chronic TTH (CTTH) have an altered pain perception compared to healthy controls. METHODS We applied a pressure of five increasing intensities to m. trapezius and m. temporalis with a Somedic Algometer II. Visual analogue scale-score was rated and area under the curve (AUC) calculated. An average AUC in each person was used as an outcome variable in further univariate multiple linear regression analysis because factor analysis showed that AUC represents only one dimension underlying both muscles. RESULTS Participants included 22 children with FETTH, 36 children with CTTH and 57 controls. The CTTH group had a significantly higher AUC compared to the control group ( P < 0.001). The FETTH group represented an intermediate state. AUC did not change with increasing age, headache years, headache intensity, headache frequency or sex. CONCLUSION Children with CTTH show significantly increased pain sensitivity in a range of pressures compared to the FETTH group and the controls. Since AUC in m. trapezius and m. temporalis represents only one general latent tenderness, it might indicate that the altered pain perception is mainly due to central sensitisation.
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Affiliation(s)
- Ann-Britt L Soee
- Department of Paediatrics, Children's Headache Clinic, Copenhagen University Hospital Herlev, Denmark.
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Soee ABL, Thomsen LL, Tornoe B, Skov L. Reliability of four experimental mechanical pain tests in children. J Pain Res 2013; 6:103-10. [PMID: 23403523 PMCID: PMC3569048 DOI: 10.2147/jpr.s38514] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose In order to study pain in children, it is necessary to determine whether pain measurement tools used in adults are reliable measurements in children. The aim of this study was to explore the intrasession reliability of pressure pain thresholds (PPT) in healthy children. Furthermore, the aim was also to study the intersession reliability of the following four tests: (1) Total Tenderness Score; (2) PPT; (3) Visual Analog Scale score at suprapressure pain threshold; and (4) area under the curve (stimulus–response functions for pressure versus pain). Participants and methods Twenty-five healthy school children, 8–14 years of age, participated. Test 2, PPT, was repeated three times at 2 minute intervals on the same day to estimate PPT intrasession reliability using Cronbach’s alpha. Tests 1–4 were repeated after median 21 (interquartile range 10.5–22) days, and Pearson’s correlation coefficient was used to describe the intersession reliability. Results The PPT test was precise and reliable (Cronbach’s alpha ≥ 0.92). All tests showed a good to excellent correlation between days (intersessions r = 0.66–0.81). There were no indications of significant systematic differences found in any of the four tests between days. Conclusion All tests seemed to be reliable measurements in pain evaluation in healthy children aged 8–14 years. Given the small sample size, this conclusion needs to be confirmed in future studies.
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Affiliation(s)
- Ann-Britt L Soee
- Department of Pediatrics, Children's Headache Clinic, Copenhagen University Hospital Herlev, Copenhagen, Denmark
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Caviness V, Ebinger F. Headache in pediatric practice. HANDBOOK OF CLINICAL NEUROLOGY 2013; 112:827-838. [PMID: 23622290 DOI: 10.1016/b978-0-444-52910-7.00002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- V Caviness
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Tornoe B, Skov L. Computer Animated Relaxation Therapy in Children Between 7 and 13 Years with Tension-Type Headache: A Pilot Study. Appl Psychophysiol Biofeedback 2011; 37:35-44. [DOI: 10.1007/s10484-011-9173-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Siniatchkin M, Gerber-von Müller G, Darabaneanu S, Petermann F, Stephani U, Gerber WD. Behavioural treatment programme contributes to normalization of contingent negative variation in children with migraine. Cephalalgia 2010; 31:562-72. [PMID: 21059624 DOI: 10.1177/0333102410388434] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Migraine is a disorder of central information processing which may be characterized by increased amplitudes and reduced habituation of evoked and event-related potentials. In this pilot study, special behavioural training of habituation to aversive stimuli (MIPAS-Family = Migraine Patient Seminar for Families) was developed and proven effective in children suffering from migraine without aura. METHODS 13 children with migraine participated in the MIPAS-Family programme and 13 other children with migraine were treated with biofeedback. The influence of both treatments on abnormal cortical information processing in migraine was assessed using recordings of the contingent negative variation (CNV), an event-related slow cortical potential. RESULTS Both MIPAS training and biofeedback caused an equal reduction of migraine frequency and severity. However, MIPAS treatment was associated with a significant increase in iCNV habituation. Changes in the clinical course of migraine correlated positively with normalization of habituation: the greater the reduction in headache frequency, the greater the increase in CNV habituation was. These effects were not observed in the biofeedback group. CONCLUSIONS This study demonstrates that the specific treatment programme which was evolved from knowledge of pathogenetic mechanisms of migraine influences central information processing and leads to a clinical effect.
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Affiliation(s)
- Michael Siniatchkin
- Neuropaediatric Department, Paediatric Hospital, Christian-Albrechts-University, Schwanenweg 20, Kiel, Germany.
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Gerber WD, Petermann F, Gerber-von Müller G, Dollwet M, Darabaneanu S, Niederberger U, Schulte IE, Stephani U, Andrasik F. MIPAS-Family-evaluation of a new multi-modal behavioral training program for pediatric headaches: clinical effects and the impact on quality of life. J Headache Pain 2010; 11:215-25. [PMID: 20376520 PMCID: PMC3451914 DOI: 10.1007/s10194-010-0192-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 01/12/2010] [Indexed: 11/26/2022] Open
Abstract
Several meta-analyses have demonstrated that the combination of electrical muscle activity and Temperature Biofeedback could be regarded as gold standard in chronic pediatric headaches. However, these techniques seem to be uneconomical and furthermore they are not directed to improve the social competence as well as resolve possible impairments in daily activities of the child. Therefore, multi-modal behavioral techniques have been proposed, but no studies comparing these with the gold standard were conducted. The present study compared the impact of a new multi-modal behavioral education and training program--MIPAS-Family--with a combined Biofeedback treatment, evaluating clinical efficacy as well as the effect on the quality of life (QoL) of children with chronic headaches. Thirty-four children and adolescents with recurrent headache, ranging from 7 to 16 years, were randomly assigned to the MIPAS-Family (N = 19) or the Biofeedback (N = 15) condition. All patients were diagnosed by the criteria of the International Headache Society. The children and their parents completed headache diaries, diaries of daily living activities and a QoL questionnaire (KINDL). Both groups showed significant improvements concerning the headache intensity and headache duration. We found no significant differences in the main headache parameters between both treatments. After the treatments, the children were less disturbed by their headaches in the domains school, homework, and leisure time. In conclusion, MIPAS-Family is as effective as Biofeedback but it is more cost-effective and addresses the whole family and the daily activities.
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Affiliation(s)
- Wolf-Dieter Gerber
- The Institute of Medical Psychology and Medical Sociology, University of Kiel, 24113 Kiel, Germany.
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Gerber WD, Gerber-von Müller G, Petermann U, Niederberger U, Petermann F. Verbessern verhaltensmedizinische Behandlungsstrategien die Lebensqualität bei Kindern mit chronischen Kopfschmerzen? ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2009. [DOI: 10.1026/1616-3443.38.4.231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Wolf-Dieter Gerber
- Institut für Medizinische Psychologie und Medizinische Soziologie des Universitätsklinikums Schleswig-Holstein, Campus Kiel
| | - Gabriele Gerber-von Müller
- Institut für Medizinische Psychologie und Medizinische Soziologie des Universitätsklinikums Schleswig-Holstein, Campus Kiel
| | - Ulrike Petermann
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
| | - Uwe Niederberger
- Institut für Medizinische Psychologie und Medizinische Soziologie des Universitätsklinikums Schleswig-Holstein, Campus Kiel
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
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Cuvellier JC. [Management of chronic daily headache in children and adolescents]. Rev Neurol (Paris) 2008; 165:521-31. [PMID: 19041108 DOI: 10.1016/j.neurol.2008.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 08/06/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
Abstract
Chronic daily headache (CDH) affects 2 to 4% of adolescent females and 0,8 to 2% of adolescent males. CDH is diagnosed when headaches occur more than 4 hours a day, for greater than or equal to 15 headache days per month, over a period of 3 consecutive months, without an underlying pathology. It is manifested by severe intermittent headaches, that are migraine-like, as well as a chronic baseline headache. Silberstein and Lipton divided patients into four diagnostic categories: transformed migraine, chronic tension-type headache, new daily-persistent headache, and hemicrania continua. The second edition of the International Classification of Headache Disorders did not comprise any CDH category as such, but provided criteria for all four types of CDH: chronic migraine, chronic tension-type headache, new daily-persistent headache, and hemicrania continua. Evaluation of CDH needs to include a complete history and physical examination to identify any possibility of the headache representing secondary headaches. Children and adolescents with CDH frequently have sleep disturbance, pain at other sites, dizziness, medication-overuse headache and a psychiatric comorbidity (anxiety and mood disorders). CDH frequently results in school absence. CDH management plan is dictated by CDH subtype, the presence or absence of medication overuse, functional disability and presence of attacks of full-migraine superimposed. Reassuring, explaining, and educating the patient and family, starting prophylactic therapy and limiting aborting medications are the mainstay of treatment. It includes pharmacologic (acute and prophylactic therapy) and nonpharmacologic measures (biobehavioral management, biofeedback-assisted relaxation therapy, and psychologic or psychiatric intervention). Part of the teaching process must incorporate life-style changes, such as regulation of sleep and eating habits, regular exercise, avoidance of identified triggering factors and stress management. Emphasis must be placed on preventive measures rather than on analgesic or abortive strategies. Stressing the reintegration of the patient into school and family activities and assessing prognosis are other issues to address during the first visit. There are limited data evaluating the outcome of CDH in children and adolescents.
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Affiliation(s)
- J-C Cuvellier
- Service de neuropédiatrie, clinique de pédiatrie, hôpital Roger-Salengro, centre hospitalier régional et universitaire de Lille, rue du Professeur-Laine, 59037 Lille cedex, France.
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Abstract
Headaches in children and adolescents are still under-diagnosed. 75% of children are affected by primary headache by the age of 15 with 28% fitting the ICHD2 criteria of migraine. Migraine is considered a chronic disorder that can severely impact a child's daily activities, including schooling and socializing. Early recognition and aggressive therapy, with acute and prophylactic treatments, as well as intensive biobehavioral interventions, are essential to control the migraine attacks and reverse the progression into intractable disabling headache.
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Affiliation(s)
- Marielle A Kabbouche
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Division of Neurology, MLC #2015, 3333 Burnet Avenue, Cincinnati, OH, USA.
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Cottrell C, Drew J, Gibson J, Holroyd K, O'Donnell F. Feasibility assessment of telephone-administered behavioral treatment for adolescent migraine. Headache 2007; 47:1293-302. [PMID: 17927645 PMCID: PMC2128717 DOI: 10.1111/j.1526-4610.2007.00804.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the feasibility of administering behavioral migraine management training by telephone (TAT) and the acceptability of TAT to adolescents with episodic migraine. METHODS 34 adolescents (M = 14 years) with migraine (M = 3.6 migraines/month; M = 29.2 hours duration) were randomly assigned to a two-month telephone administered behavioral migraine management program (TAT) or to a standard Triptan Treatment (TT). Outcome was assessed at three- and eight-month evaluations. Participants completed a daily migraine diary that yielded information about number, duration and severity of migraines and migraine-related disability, as well as the Migraine Specific Quality of Life Questionnaire - Adolescent. In addition, TAT participants evaluated key aspects of the TAT program using 5-point Likert-like rating scales. Lastly, the ability of adolescents to demonstrate specific headache management skills following TAT was assessed. RESULTS All fifteen adolescents who entered TAT successfully demonstrated either full or partial mastery of two or more skills and nearly half demonstrated at least partial mastery of all four skills evaluated. Ninety three percent of the TAT participants reported having a positive relationship with their phone counselor. They also reported a preference for the telephone-based treatment over in-clinic visits and rated the manual and tapes as helpful. Treatment effects (in terms of percent improvement) ranged from consistently large across both evaluations for improvement in number of migraines (54% and 71%), disability equivalent hours (80% and 63%) and quality of life (44% and 48%), to moderate or variable for migraine duration (35% and 23%) and severity (30% and 34%). The TT group also showed clinically meaningful reductions in headache parameters and improvements in quality of life. CONCLUSIONS Completion rates for TAT were high; adolescents evaluated their experience with TAT positively and were able to exhibit key behavioral headache management skills following treatment. While clinically significant improvements in migraine and migraine-related disability/quality of life were observed with both TAT and treatment as usual (triptan therapy), the small study size and the absence of a control group do not permit conclusions about the effectiveness of either treatment. Nonetheless these results indicate TAT may be a promising treatment format for improving access to behavioral treatments for underserved adolescents and justifies further evaluation of TAT both alone and in combination with drug therapy.
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Affiliation(s)
- Constance Cottrell
- Headache Treatment and Research Project--Ohio University, Westerville, OH 43081, USA
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Abstract
Most clinicians agree that psychological factors are important considerations in the evaluation and treatment of headache patients. There has been a lack of systematic research, however, that has examined the relationship between these variables. Attention to such factors may become a greater concern as the frequency of a patient's headaches increases, there is increased disability secondary to headaches, and/or there is an inadequate response to usually effective treatment. In addition, there is no consensus as to the proper method to assess psychopathology in headache patients.
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Affiliation(s)
- Randall Weeks
- New England Institute for Behavioral Medicine, Stamford, CT, USA
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Abstract
Post-traumatic headache after craniocerebral trauma is not an uncommon occurrence in children and adolescents. It can occur after mild, moderate, or severe injury. The headache may have features of tension-type headache, migraine, or probable migraine and is rarely seen in isolation. It is often part of a syndrome encompassing a variety of somatic and psychobehavioral symptoms. In time, the headache and accompanying symptoms gradually resolve over a period of 8 to 12 weeks. However, sometimes it may become chronic, requiring a multidimensional management approach including pharmacologic intervention, physical rehabilitation, and cognitive-behavioral therapy as used in the adult population.
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Affiliation(s)
- Maria-Carmen B Wilson
- University of South Florida, Department of Neurology, 12901 Bruce B. Downs Boulevard, MDC 55, Tampa, FL 33612, USA.
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