Migraine, attention deficit hyperactivity disorder and screen time in children attending a Sri Lankan tertiary care facility: are they associated?

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.

Screen Time and Its Health Consequences in Children and Adolescents

Nowadays, children and adolescents are exposed to digital media (DM) from an early age. Therefore, specific guidelines have been published by the World Health Organization, whose aim is to limit daily screen time (ST) viewing. However, during the COVID-19 pandemic, a rise in DM use, and consequently ST viewing, was observed. More and more aspects of modern life are thought to be affected by excessive ST viewing. Accordingly, the aim of this review is to document the health effects of excessive ST viewing on children and adolescents. A narrative review was performed in searchable databases. In total, 43 original articles were considered. Excessive ST viewing was correlated with increased risk for obesity and other cardiometabolic risk factors, mental health, unhealthy dietary habits and eating disorders, and problems in development and child-parent relationships. Sleep, physical activity, eyesight, headaches, and the musculoskeletal system were negatively affected as well. However, the effect of ST was weighted by the type of media used and the way types of media were used. Other confounding factors were reported. There is evidence to suggest a negative correlation between excessive ST and youth health exists. Nevertheless, more research is needed if this correlation is to be established.

Primary headache disorders in adolescents in North- and South-Tyrol: Findings of the EVA-Tyrol-Study

OBJECTIVE

Assessment of the prevalence of primary headache disorders, associated risk factors and use of acute/preventive medication in a representative large sample of adolescents.

METHODS

Within the EVA-Tyrol project, a community-based non-randomized controlled cross-sectional study, data was collected from adolescents aged 14-19 years from 45 sites across North-, East- and South Tyrol. Headaches were classified according to the latest ICHD-3 and assessed by headache specialists in face-to-face interviews.

FINDINGS

Of 1923 participants 930 (48.4%) reported having headaches. Female to male ratio was 2:1. Migraine, tension-type headache and other headache were diagnosed in 10%, 30.2% and 8.2% respectively. Medication overuse was diagnosed in 3.4%, increasing up to 21.7% in participants with chronic headache. The use of preventative medication was not reported by any adolescent. Sleep disturbances (p < 0.05), alcohol consumption (p < 0.05), low physical activity (p < 0.01) and high screen time exposure (p < 0.01) were associated with an increased risk of headaches.

CONCLUSION

We report high prevalence of primary headache disorders and medication overuse in a large community-based sample of teenagers. Acute and preventive non-drug and pharmacological treatments are not established due to lack of paediatric headache outpatient clinics. Promoting health education in teenagers and encouraging public awareness, including that of health care providers is pivotal.Trial registration: EVA-Tyrol has been retrospectively registered at clinicaltrials.gov under https://clinicaltrials.gov/ct2/show/NCT03929692 since April 29, 2019.

Headache in Children and Adolescents: The Association between Screen Time and Headache within a Clinical Headache Population

BACKGROUND

More than half of children and adolescents have experienced headache within the last 3 months. Several risk factors for headache have been identified, including obesity and lack of sleep. The association between screen time and headache in children and adolescents is sparsely investigated. The aim of this study was to assess this association and evaluate if it varied according to headache diagnosis.

METHOD

This cross-sectional study was performed at the tertiary pediatric outpatient clinic for headache at Herlev University Hospital. A total of 139 participants who answered a questionnaire on lifestyle factors and their daily living were included. Diagnoses of migraine and tension-type headache (TTH) were made according to the International Classification of Headache Disorders-3. Children with both migraine and TTH were allocated to a mixed headache group. We differentiated between total, leisure, and school-related screen time.

RESULTS

The mean age was 13.20 ± 3.38 years and 53.2% were girls. Note that 25.2% were diagnosed with migraine without aura, 23.0% migraine with aura, 28.1% TTH, 15.8% mixed headache, and 7.9% had an unclassified headache diagnosis at the time of inclusion. There was no statistically significant difference in screen time across the five headache groups. An association between screen time and headache frequency was found in children with migraine with aura.

CONCLUSION

In this study, we investigated the association between screen time and headache in children and adolescents. More screen time was associated with more frequent headaches in children with migraine with aura. Future prospective studies are needed to determine the causality of this association.

Interictal Cognitive Performance in Children and Adolescents With Primary Headache: A Narrative Review

Primary headache is a very common and disabling disease. The burden of pain and recurrent attacks may lead to a poor quality of life, anxiety and depression. An increased risk of low functioning and curricular performances in young patients with primary headache has been described. The mechanisms underlying the relationship between migraine and poor school achievement may be various and could be a reflection of weak cognitive skills. Data concerning the cognitive functioning in the free pain interval in pediatric age are under-investigated and results are far from conclusive. The present review article suggests that, though considered a benign disease, pediatric migraine may be associated to altered neuropsychological functioning in the interictal phase. Although children and adolescents with migraine generally have a normal intelligence, they may show a not homogeneous cognitive profile, characterized by possible difficulties in verbal skills, in particular comprehension abilities. Pediatric primary headache may present altered neuropsychological functioning involving attentional resources, processing speed and memory, particularly verbal memory. Given the impact that this disease can have on school performance and the tendency to persist from childhood to adulthood, a cognitive screening in young patients affected by primary headache is pivotal. Additional neuropsychological research using more homogenous methods is needed.

Electronic screen device usage and screen time among preschool-attending children in a suburban area of Sri Lanka

Background

Excessive use of screen devices and screen time are increasing health problems in children. We aim to describe the electronic screen device usage and determine the factors associated with their use among preschool-attending children in a suburban population in Sri Lanka.

Methods

A cross-sectional study was conducted in a suburban Medical Officer of Health area of Sri Lanka from January to March 2020. All children aged between 36–59 months attending ten randomly selected preschools were recruited. Data were collected using a parent-administered questionnaire and analysed using binary logistic regression in SPSS. The prevalence of electronic device usage, the average time spent on each device, and factors associated with individual device usage were analysed.

Results

A total of 340 children (Male-48%; mean age-50.1 ± 6.9 months) were recruited. Electronic devices were used by 96% of children. The most common devices were the television (87%) and the smartphone (63%). Of the children who used electronic devices, 60% exceeded the recommended screen time limit of one hour per day, 21% used devices for more than two hours per day, and 51% commenced using devices by two years of age. The higher education level of the father was independently associated with the use of smartphones and laptops and daily screen time of more than one hour (p < 0.05 for all). Male sex and being the only child were significantly associated with the use of smartphones, whereas maternal employment was associated with the use of laptops (p < 0.05 for all).

Conclusions

Electronic screen devices were used by 96% of preschool-attending children, and over 60% used them for more than the recommended daily upper limit of one hour. Higher paternal education, maternal employment and being the only child were significantly associated with electronic screen device use.

[Comorbidity in migraine]

Migraine is a common and often disabling disease with a prominent genetic basis. There are many comorbidities associated with migraine which have been identified as risk factors for progression to chronic migraine. Each of these has its own genetic load and shares some common characteristics with migraine. The identification of migraine comorbidities may help clarify common underlying genetic and biological mechanisms of diseases. The treatment of migraine should involve a multifaceted approach, aimed at identifying and reducing possible risk and comorbidity factors. This may prevent the evolution toward a chronic form and then toward pharmacological resistance.

Screen Time for Preschool Children: Learning from Home during the COVID-19 Pandemic

Because of the COVID-19 pandemic, the Indonesian Government enacted a study at home policy for all students. This policy also applied to preschool children aged 2 to 6 years old. The purpose of the research was to examine the duration and impact of digital media use by preschool children in urban areas in Indonesia during weekdays and weekends. Data were collected using a validated questionnaire called the Surveillance of digital-Media hAbits in earLy chiLdhood Questionnaire (SMALLQ^®). A total of 951 parents or guardians (17-70 years old) who had preschool children volunteered to complete the questionnaire online. Preschool children have been using screen media since infancy, and the time they spend on-screen time is more than 1 hour per day. The digital media most used were mobile phones (91.6%), followed by television (86.1%) and computers (61%). The parents realized the impact and the importance of limiting time of screen media, but it difficult to prevent their children from using it, especially when learning from home. Hence, there is a need different approach to learning from home, especially to manage the duration of screen time for preschool children.