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Lipton RB, Buse DC, Nahas SJ, Tietjen GE, Martin VT, Löf E, Brevig T, Cady R, Diener HC. Risk factors for migraine disease progression: a narrative review for a patient-centered approach. J Neurol 2023; 270:5692-5710. [PMID: 37615752 PMCID: PMC10632231 DOI: 10.1007/s00415-023-11880-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND In individuals with migraine, attacks may increase in frequency, severity, or both. Preventing migraine progression has emerged as a treatment goal in headache subspecialty practice, but there may be less awareness in general neurology or primary care settings where most people with migraine who seek treatment consult. Herein, we review the definition of and risk factors for migraine progression and consider strategies that could reduce its risk. METHODS A group of headache expert healthcare professionals, clinicians, and researchers reviewed published evidence documenting factors associated with increased or decreased rates of migraine progression and established expert opinions for disease management recommendations. Strength of evidence was rated as good, moderate, or based solely on expert opinion, using modified criteria for causation developed by AB Hill. RESULTS Migraine progression is commonly operationally defined as the transition from ≤ 15 to ≥ 15 monthly headache days among people with migraine; however, this does not necessarily constitute a fundamental change in migraine biology and other definitions should be considered. Established and theoretical key risk factors for migraine progression were categorized into five domains: migraine disease characteristics, treatment-related factors, comorbidities, lifestyle/exogenous factors, and demographic factors. Within these domains, good evidence supports the following risk factors: poorly optimized acute headache treatment, cutaneous allodynia, acute medication overuse, selected psychiatric symptoms, extra-cephalic chronic pain conditions, metabolism-related comorbidities, sleep disturbances, respiratory conditions, former/current high caffeine intake, physical inactivity, financial constraints, tobacco use, and personal triggers as risk factors. Protective actions that may mitigate migraine progression are sparsely investigated in published literature; our discussion of these factors is primarily based on expert opinion. CONCLUSIONS Recognizing risk factors for migraine progression will allow healthcare providers to suggest protective actions against migraine progression (Supplementary Fig. 1). Intervention studies are needed to weight the risk factors and test the clinical benefit of hypothesized mitigation strategies that emerge from epidemiological evidence.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Vector Psychometric Group, LLC, Chapel Hill, NC, USA
| | - Stephanie J Nahas
- Department of Neurology, Thomas Jefferson University, Jefferson Headache Center, Philadelphia, PA, USA
| | - Gretchen E Tietjen
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Vincent T Martin
- University of Cincinnati Headache and Facial Pain Center, Cincinnati, OH, USA
| | - Elin Löf
- H. Lundbeck A/S, Copenhagen, Denmark
| | | | - Roger Cady
- Lundbeck LLC, Deerfield, IL, USA
- RK Consults, Ozark, MO, USA
- Missouri State University, Springfield, MO, USA
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany.
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Quispe-Vicuña C, Soriano-Moreno DR, De-Los-Rios-Pinto A, Díaz-Ledesma LA, Fernandez-Guzman D, Pacheco-Barrios K, Alva-Diaz C. Association between weight status and migraine in the paediatric population: a systematic review and meta-analysis. Front Neurol 2023; 14:1225935. [PMID: 38033769 PMCID: PMC10682819 DOI: 10.3389/fneur.2023.1225935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction An association between weight status and migraine has been previously reported; however, this relationship has only been studied in adults, not in the paediatric population. Objective To evaluate the association between weight status and migraine in the paediatric population. Methods We searched PubMed/Medline, Scopus, Web of Science, Ovid Medline, and Embase using a cut-off date of May 2023. We included observational studies that evaluated the association between weight status (underweight, overweight, obese, and excess weight) and migraine in the paediatric population (children and adolescents). Normal weight was the comparator. The outcome was migraine (all types, episodic and chronic). We performed meta-analyses using a random-effects model to estimate the pooled effects for each outcome. Sensitivity analysis was performed based on study design and risk of bias (using the Newcastle-Ottawa Scale). Certainty of evidence was assessed using the GRADE approach. Results Eight studies (6 cross-sectional, 1 case-control and 1 cohort) covering 16,556 patients were included. The overall certainty of evidence was very low for the association between overweight, obesity, and excess weight with migraine. In the sensitivity analysis, meta-analyses of studies with a low risk of bias found that the overweight population probably had an increased odds of migraine (OR: 1.70; 95% CI: 1.14 to 2.53; I2 = 32.3%, p = 0.224) and that excess weight may increase the odds of migraine (OR: 1.58; 95% CI: 1.06 to 2.35; I2 = 83.7%, p = 0.002). Additionally, cohort and case-control studies found that obesity probably increases the odds of migraine. No studies analysed the association between underweight and migraine. Conclusion The associations between overweight, obesity, excess weight and migraine were uncertain, but studies with better methodological quality reported increased odds. Future longitudinal studies with proper confounding control are needed to disentangle their causal relationship. Systematic review registration PROSPERO, identifier CRD42021271533.
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Affiliation(s)
- Carlos Quispe-Vicuña
- Sociedad Científica de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
| | - David R. Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Facultad de Medicina, Universidad Peruana Unión, Lima, Peru
| | - Abraham De-Los-Rios-Pinto
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
| | - Luz A. Díaz-Ledesma
- Veritas Sociedad Científica de Estudiantes de Medicina, Universidad de San Martín de Porres, Chiclayo, Peru
| | | | - Kevin Pacheco-Barrios
- Unidad de Investigación para la Generación y Síntesis de Evidencia en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- Neuromodulation Center y Center for Clinical Research Learning, Spaulding Rehabilitation Hospital y Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Departamento de Epidemiología, Escuela de Salud Pública T. H. Chan de Harvard, MA, United States
| | - Carlos Alva-Diaz
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
- Universidad Señor de Sipán, Chiclayo, Peru
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
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Ali M, Asghar N, Hannah T, Schupper AJ, Li A, Dreher N, Murtaza-Ali M, Vasan V, Nakadar Z, Alasadi H, Lin A, Hrabarchuk E, Quinones A, McCarthy L, Asfaw Z, Dullea J, Gometz A, Lovell M, Choudhri T. A multicenter, longitudinal survey of headaches and concussions among youth athletes in the United States from 2009 to 2019. J Headache Pain 2023; 24:6. [PMID: 36755244 PMCID: PMC9909942 DOI: 10.1186/s10194-022-01528-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/17/2022] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE/ BACKGROUND Chronic headaches and sports-related concussions are among the most common neurological morbidities in adolescents and young adults. Given that the two can overlap in presentation, studying the effects of one on another has proven difficult. In this longitudinal study, we sought to assess the relationship between chronic headaches and concussions, analyzing the role of historic concussions on chronic headaches, as well as that of premorbid headaches on future concussion incidence, severity, and recovery. METHODS This multi-center, longitudinal cohort study followed 7,453 youth athletes who were administered demographic and clinical surveys as well as a total of 25,815 Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) assessments between 2009 and 2019. ImPACT was administered at baseline. Throughout the season concussions were examined by physicians and athletic trainers, followed by re-administration of ImPACT post-injury (PI), and at follow-up (FU), a median of 7 days post-concussion. Concussion incidence was calculated as the total number of concussions per patient years. Concussion severity and recovery were calculated as standardized deviations from baseline to PI and then FU in Symptom Score and the four neurocognitive composite ImPACT scores: Verbal Memory, Visual Memory, Processing Speed, and Reaction Time. Data were collected prospectively in a well-organized electronic format supervised by a national research-oriented organization with rigorous quality assurance. Analysis was preformed retrospectively. RESULTS Of the eligible athletes, 1,147 reported chronic headaches (CH) at the start of the season and 6,306 reported no such history (NH). Median age of the cohort was 15.4 ± 1.6 years, and students were followed for an average of 1.3 ± 0.6 years. A history of concussions (OR 2.31, P < 0.0001) was associated with CH. Specifically, a greater number of past concussions (r2 = 0.95) as well as concussions characterized by a loss of consciousness (P < 0.0001) were associated with more severe headache burden. The CH cohort had a greater future incidence of concussion than the NH cohort (55.6 vs. 43.0 per 100 patient-years, P < 0.0001). However, multivariate analysis controlling for demographic, clinical, academic, and sports-related variables yielded no such effect (OR 0.99, P = 0.85). On multivariable analysis the CH cohort did have greater deviations from baseline to PI and FU in Symptom Score (PI OR per point 1.05, P = 0.01, FU OR per point 1.11, P = 0.04) and Processing Speed (OR per point 1.08, P = 0.04), suggesting greater concussion severity and impaired symptomatic recovery as compared to the NH cohort. CONCLUSION A history of concussions was a significant contributor to headache burden among American adolescents and young adults. However, those with chronic headaches were not more likely to be diagnosed with a concussion, despite presenting with more severe concussions that had protracted recovery. Our findings not only suggest the need for conservative management among youth athletes with chronic headaches, they also indicate a potential health care gap in this population, in that those with chronic headaches may be referred for concussion diagnosis and management at lower rates than those with no such comorbidity.
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Affiliation(s)
- Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA.
| | - Nek Asghar
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Theodore Hannah
- Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, 19140, Philadelphia, PA, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Adam Li
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, 14642, Rochester, NY, USA
| | - Nickolas Dreher
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 10032, NY, USA
| | - Muhammad Murtaza-Ali
- Department of Anthropology, State University of New York at Binghamton, 13902, NY, USA
| | - Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Zaid Nakadar
- Department of Neurosurgery, State University of New York Downstate Health Sciences University, 11203, NY, USA
| | - Husni Alasadi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Anthony Lin
- Department of Pathology, Joan & Sanford I. Weill Medical College of Cornell University, 10021, NY, USA
| | - Eugene Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Zerubabbel Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Jonathan Dullea
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Alex Gometz
- Concussion Management of New York, 10021, NY, USA
| | - Mark Lovell
- Department of Neurology, The University of Pittsburgh Medical Center, 15260, Pittsburgh, PA, USA
| | - Tanvir Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
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Bu XX, Zhu LH, Wang ZM, Lu C, Chen H, Yu D. Association of obesity with headache among US children and adolescents: Evidence from NHANES 1999-2004. Front Endocrinol (Lausanne) 2023; 13:1072419. [PMID: 36686472 PMCID: PMC9849580 DOI: 10.3389/fendo.2022.1072419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Abstract
Background Children and adolescents increasingly commonly suffer from obesity and headache. It has been confirmed that there is an association between obesity and headache in adults; however, evidence of such an association in paediatric populations is still controversial. Therefore, this study examined the relationship between obesity and headache among children and adolescents in the US. Methods The cross-sectional data of 3948 participants were obtained from the National Health and Nutrition Examination Survey 1999-2004. Weighted logistic regression models were applied to investigate the association between obesity and headache. Subgroup analysis stratified by sex and age was performed to explore the potential difference in the association of paediatric obesity with headache. The performance of paediatric obesity on headache was assessed by receiver operating characteristic (ROC) curve. Results The present study involved 3948 participants, of whom 713 (18.1%) had headache. Compared to those without headache, participants with headache tended to be girls and adolescents, have less calcium intake, and have higher levels of body mass index (BMI), C-reactive protein (CRP), serum ferritin and triglycerides (TGs) (all P < 0.05). After fully adjusting for potential confounders, the ORs with 95% CIs for headache were 1.03 (0.58-1.54) and 1.25 (0.68-2.30) for overweight and obese participants in comparison with normal-weight controls, respectively, implying no association of paediatric obesity with headache independent of other potential confounding factors. In addition, although higher odds of headache were noted in girls and adolescents (aged 10-17 years), no statistically significant difference was found across any subgroups. The area under the ROC (AUC) of paediatric obesity on headache was 0.634. Conclusions In summary, our study indicated that obesity is not associated with headache among US children and adolescents. Further prospective studies with larger sample size are needed to validate our findings.
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Affiliation(s)
- Xin-Xin Bu
- Department of Paediatric, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang-Hua Zhu
- Department of Paediatric, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ze-Mu Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Lu
- Department of Paediatric, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Chen
- Department of Paediatric, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Di Yu
- Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
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Falla K, Kuziek J, Mahnaz SR, Noel M, Ronksley PE, Orr SL. Anxiety and Depressive Symptoms and Disorders in Children and Adolescents With Migraine: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:1176-1187. [PMID: 36315158 PMCID: PMC9623478 DOI: 10.1001/jamapediatrics.2022.3940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/19/2022] [Indexed: 11/05/2022]
Abstract
Importance Though it is presumed that children and adolescents with migraine are at risk of internalizing symptoms and disorders, high-level summative evidence to support this clinical belief is lacking. Objective To determine if there is an association between internalizing symptoms and disorders and migraine in children and adolescents. Data Sources A librarian-led, peer-reviewed search was performed using MEDLINE, Embase, PsycINFO, and CINAHL databases (inception to March 28, 2022). Study Selection Case-control, cohort, and cross-sectional studies on the association between internalizing symptoms and disorders and migraine in children and adolescents 18 years or younger were eligible. Data Extraction and Synthesis Two investigators independently completed abstract and full-text screening, data extraction, and quality appraisal using the Newcastle-Ottawa scales. Studies were pooled with random-effects meta-analyses using standardized mean differences (SMD) or odds ratios (OR) with 95% CIs. Where sufficient data for pooling were unavailable, studies were described qualitatively. Main Outcomes and Measures The primary outcome was migraine diagnosis; additional outcomes included migraine outcomes and incidence. Associations between these outcomes and internalizing symptoms and disorders were evaluated. Results The study team screened 4946 studies and included 80 studies in the systematic review. Seventy-four studies reported on the association between internalizing symptoms and disorders and migraine, and 51 studies were amenable to pooling. Meta-analyses comparing children and adolescents with migraine with healthy controls showed: (1) an association between migraine and anxiety symptoms (SMD, 1.13; 95% CI, 0.64-1.63); (2) an association between migraine and depressive symptoms (SMD, 0.67; 95% CI, 0.46-0.87); and (3) significantly higher odds of anxiety disorders (OR, 1.93, 95% CI, 1.49-2.50) and depressive disorders (OR, 2.01, 95% CI, 1.46-2.78) in those with, vs without, migraine. Stratification of results did not reveal differences between clinical vs community/population-based samples and there was no evidence of publication bias. Twenty studies assessing the association between internalizing symptoms or disorders and migraine outcomes (n = 18) or incident migraine (n = 2) were summarized descriptively given significant heterogeneity, with minimal conclusions drawn. Conclusions and Relevance In this study, children and adolescents with migraine were at higher risk of anxiety and depression symptoms and disorders compared with healthy controls. It may be beneficial to routinely screen children and adolescents with migraine for anxiety and depression in clinical practice. It is unclear whether having anxiety and depressive symptoms or disorders has an affect on migraine outcomes or incidence.
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Affiliation(s)
- Katherine Falla
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Kuziek
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Syeda Rubbia Mahnaz
- Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Paul E. Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Serena L. Orr
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Tekin H, Edem P. Effects and side effects of migraine prophylaxis in children. Pediatr Int 2022; 64:e15094. [PMID: 34905279 DOI: 10.1111/ped.15094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/29/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Migraine is the primary cause of headache in children. Most patients can be treated with lifestyle changes and acute attack prophylaxis. Prophylaxis should be considered when symptoms cause frequent school absenteeism, poor quality of life, recurring emergency room visits, and frequent analgesic use. We aimed to compare the efficacy and side effects of drugs used in migraine prophylaxis, chosen according to the clinical and/or demographic characteristics of the patients. METHODS One hundred eighty-six patients aged 6-18 years were evaluated and who were diagnosed with migraine according to The International Classification of Headache Disorders, 3rd edition beta version (ICH-3β). Propranolol, topiramate, flunarizine, and cyproheptadine were given as prophylactic treatment. The Pediatric Migraine Disability Assessment Score (PedMIDAS) score, severity, duration, and frequency of the headache attacks were evaluated from the medical records and pre- and post-treatment values were compared. RESULTS The median age of the patients was 14 years (range, 6-18 years) and the mean duration of headache was 29.6 ± 21.02 months. The mean PedMIDAS score was 29.9 ± 21.2 before and 14.9 ± 12.5 after treatment. Most reduction in the frequency of attacks was observed in the topiramate group. All four drugs significantly reduced the PedMIDAS score. The most common side effect was palpitations. CONCLUSIONS Significant improvement was found in PedMIDAS scores in all drug groups. Topiramate was found to be the most effective drug in reducing the frequency of attacks. All four drugs in this study may be utilized for migraine prophylaxis in terms of effectiveness and safety.
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Affiliation(s)
- Hande Tekin
- Division of Pediatric Neurology, Department of Pediatrics, Bakircay University Cigli Training and Research Hospital, Izmir, Turkey
| | - Pınar Edem
- Division of Pediatric Neurology, Department of Pediatrics, Bakircay University Cigli Training and Research Hospital, Izmir, Turkey
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The Psychiatric Comorbidities of Migraine in Children and Adolescents. Curr Pain Headache Rep 2021; 25:69. [PMID: 34766216 DOI: 10.1007/s11916-021-00983-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Understanding comorbidities in migraine is important because it can help us understand disease pathophysiology while also aiding the development of more effective treatment strategies. Additionally, it can provide greater awareness about appropriate diagnosis, the need for additional disease screening, and the natural history of migraine. Psychiatric comorbidities have been independently studied in both adults and children with migraine because their presentations can be distinct, and the physiology in these two groups can be different. RECENT FINDINGS While symptoms of anxiety and depression seem to be comorbid with migraine in children, clinically significant disease does not appear to be, though the clarity of these data is limited by overlap between migraine symptomatology and that assessed by many screening tools. Functional neurologic disorders like psychogenic non-epileptic episodes (PNEE) and other functional movement disorders are not common but can be comorbid with migraine in this population and tend to improve with migraine treatment. The number of adverse childhood experiences (ACEs) a child is exposed to seems to be near-linearly associated with risk of migraine, but not with tension-type headache (TTH). The findings from these studies underscore the importance of utilizing appropriate screening methodologies for identifying psychiatric disorders in children with migraine. Additionally, the role of the insula, the hypothalamic-pituitary-adrenal axis, the serotonergic system, and the instability of hyperactivated neural networks may underlie the pathophysiology of both migraine and its psychiatric comorbidities.
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Abstract
PURPOSE OF REVIEW This article reviews the approach to a child or adolescent with headache, the criteria for common diagnoses, and the evidence base for treatments. RECENT FINDINGS The guidelines for acute and preventive treatment of migraine were updated in 2019. These guidelines summarize the available evidence and outline the questions that should be addressed in future research. The US Food and Drug Administration (FDA) approval of several new classes of drugs and devices to treat adult migraine in the past few years has resulted in ongoing or planned pediatric trials. SUMMARY Headache is a common symptom in children, and it is important to take a detailed history and perform a thorough physical examination to make the diagnosis. Nearly 1 in 10 children experience recurrent headaches due to migraine, which cause significant impairment in school performance and quality of life. The acute and preventive treatments that are currently available will help at least two-thirds of children with migraine, and several trials of new therapies offer hope for the future.
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Abstract
Tension-type headache (TTH) is the most prevalent neurological disorder worldwide and is characterized by recurrent headaches of mild to moderate intensity, bilateral location, pressing or tightening quality, and no aggravation by routine physical activity. Diagnosis is based on headache history and the exclusion of alternative diagnoses, with clinical criteria provided by the International Classification of Headache Disorders, third edition. Although the biological underpinnings remain unresolved, it seems likely that peripheral mechanisms are responsible for the genesis of pain in TTH, whereas central sensitization may be involved in transformation from episodic to chronic TTH. Pharmacological therapy is the mainstay of clinical management and can be divided into acute and preventive treatments. Simple analgesics have evidence-based effectiveness and are widely regarded as first-line medications for the acute treatment of TTH. Preventive treatment should be considered in individuals with frequent episodic and chronic TTH, and if simple analgesics are ineffective, poorly tolerated or contraindicated. Recommended preventive treatments include amitriptyline, venlafaxine and mirtazapine, as well as some selected non-pharmacological therapies. Despite the widespread prevalence and associated disability of TTH, little progress has been made since the early 2000s owing to a lack of attention and resource allocation by scientists, funding bodies and the pharmaceutical industry.
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Raucci U, Boni A, Evangelisti M, Della Vecchia N, Velardi M, Ursitti F, Terrin G, Di Nardo G, Reale A, Villani A, Parisi P. Lifestyle Modifications to Help Prevent Headache at a Developmental Age. Front Neurol 2021; 11:618375. [PMID: 33603708 PMCID: PMC7884344 DOI: 10.3389/fneur.2020.618375] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/29/2020] [Indexed: 12/17/2022] Open
Abstract
Headache is the world's seventh most significant cause of disability-adjusted-life in people aged between 10 and 14 years. Therapeutic management is based on pharmacological approaches and lifestyle recommendations. Many studies show associations between each migraine-promoting lifestyle, behavioral triggers, frequency, and intensity of headaches. Nevertheless, the overall aspects of this topic lack any definitive evidence. Educational programs advise that pediatric patients who suffer from migraines follow a correct lifestyle and that this is of the utmost importance in childhood, as it will improve quality of life and assist adult patients in avoiding headache chronicity, increasing general well-being. These data are important due to the scarcity of scientific evidence on drug therapy for prophylaxis during the developmental age. The "lifestyle recommendations" described in the literature include a perfect balance between regular sleep and meal, adequate hydration, limited consumption of caffeine, tobacco, and alcohol, regular physical activity to avoid being overweight as well as any other elements causing stress. The ketogenic diet is a possible new therapeutic strategy for the control of headache in adults, however, the possible role of dietary factors requires more specific studies among children and adolescents. Educational programs advise that the improvement of lifestyle as a central element in the management of pediatric headache will be of particular importance in the future to improve the quality of life of these patients and reduce the severity of cephalalgic episodes and increase their well-being in adulthood. The present review highlights how changes in different aspects of daily life may determine significant improvements in the management of headaches in people of developmental age.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | | | - Melania Evangelisti
- Department of Pediatrics, Department of Neuroscience, Mental Health & Sense Organs (NESMOS), Faculty of Medicine & Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Nicoletta Della Vecchia
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Margherita Velardi
- Department of Pediatrics, Department of Neuroscience, Mental Health & Sense Organs (NESMOS), Faculty of Medicine & Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Fabiana Ursitti
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Gianluca Terrin
- Department of Gynecological Obstetric and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Giovanni Di Nardo
- Department of Pediatrics, Department of Neuroscience, Mental Health & Sense Organs (NESMOS), Faculty of Medicine & Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Alberto Villani
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Pasquale Parisi
- Department of Pediatrics, Department of Neuroscience, Mental Health & Sense Organs (NESMOS), Faculty of Medicine & Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Headache in Children: Selected Factors of Vascular Changes Involved in Underlying Processes of Idiopathic Headaches. CHILDREN-BASEL 2020; 7:children7100167. [PMID: 33020432 PMCID: PMC7600888 DOI: 10.3390/children7100167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022]
Abstract
Headaches are common complaints in children. The International Classification of Headache Disorders, 3rd edition (beta version), defines more than 280 types of headaches. Primary headaches refer to independent conditions that cause pain and include migraine, tension-type headaches (TTH), and trigeminal autonomic cephalalgias (TACs). Several agents are involved in the pathogenesis of headaches. The factors associated with predisposition to atherosclerosis seem to be particularly important from the clinical point of view. The influence of obesity on the incidence of headaches has been well established. Moreover, idiopathic headaches, especially migraine, are thought to be one of the first signs of disorders in lipid metabolism and atherosclerosis. The risk of migraine increases with increasing obesity in children. Another factor that seems to be involved in both obesity and headaches is the adiponectin level. Recent data also suggest new potential risk factors for atherosclerosis and platelet aggregation such as brain-derived neurotrophic factor (BDNF), sCD40L (soluble CD40 ligand), serpin E1/PAI I (endothelial plasminogen activator inhibitor), and vascular endothelial growth factor (VEGF). However, their role is controversial because the results of clinical studies are often inconsistent. This review presents the current knowledge on the potential markers of atherosclerosis and platelet aggregation, which may be associated with primary headaches.
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Hancı F, Kabakuş N, Türay S, Bala KA, Dilek M. The role of obesity and vitamin D deficiency in primary headaches in childhood. Acta Neurol Belg 2020; 120:1123-1131. [PMID: 30963478 DOI: 10.1007/s13760-019-01134-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 04/02/2019] [Indexed: 02/01/2023]
Abstract
This study evaluates the role of obesity, overweight and vitamin D deficiency in primary headaches in childhood. This retrospective observational study included pediatric patients aged 5-17 years admitted to the pediatric neurology clinic with headaches between January 2015 and August 2018 and diagnosed with primary headache based on ICHD III-beta criteria. The control group consisted of healthy children without headache admitted to the pediatric outpatient clinic for check-ups before engaging in athletic or school activities. The control and patient groups were at the same risk of low 25(OH)D3 levels. The study population was divided into three groups-patients with migraine (group A), patients with tension-type headache (TTH) (group B) and the control group (group C). Participants' demographic data, medical histories, physical examination findings and laboratory results were retrieved retrospectively from the patient charts. BMI was significantly higher in patients with primary headache, the risk of primary headache increasing in patients with a BMI in excess of 25. Comparison of the patients with primary headache and the control group revealed lower 25(OH)D levels in the primary headache group, although the difference was not statistically significant. Girls with primary headache had significantly lower 25(OH)D levels than boys. A relationship may be present between overweight, obesity and primary headache, while female gender may be suggested as a negative factor for primary headache. Patients should be advised to lose weight if BMI indicates overweight or obesity.
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Okamura MN, Goldbaum M, Madeira W, Cesar CLG. Prevalence of headache and associated factors among adolescents: results of a population-based study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200067. [PMID: 32667464 DOI: 10.1590/1980-549720200067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/25/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Cephalalgia is one of the most common somatic complaints related to health problems in childhood and adolescence. OBJECTIVE To measure the cephalalgia prevalence in adolescents from the city of São Paulo, Brazil, and associated factors. METHODS This is a cross-sectional population-based study, carried out in 2015, with 539 adolescents of both sexes, aged between 15 and 19 years. The information was collected in a household survey, and the participants were selected from probabilistic sampling. Frequencies, χ2 test and logistic regression analysis were used in the study, and significance level was 5%. RESULTS the estimated prevalence of cephalalgia was 38.2% (95%CI 33.8 - 42.7), and 7.8% (95%CI 5.6 - 10.7), migraine. The associated factors for cephalalgia were: female sex (OR = 2.2; 95%CI 1.4 - 3.4), Common Mental Disorder (OR = 2.8; 95%CI 1.7 - 4.9), vision impairment (OR = 2.6; 95%CI 1.6 - 4.2), besides back pain (OR = 2.2; 95%CI 1.3 - 3.5), sinusitis (OR = 2.0; 95%CI 1.2 - 3.4) and incomplete elementary education (OR = 3.0; 95%CI 1.6 - 5.6). CONCLUSION The prevalence of headache among adolescents in the city of São Paulo represented more than 1/3 (one third) of this population. The main associated factors were sex, low schooling and the following comorbidities: common mental disorder and vision impairment.
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Affiliation(s)
- Mirna Namie Okamura
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Moisés Goldbaum
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Pan YJ, Chen YC, Lu SR, Juang KD, Chen SP, Wang YF, Fuh JL, Wang SJ. The influence of friendship on migraine in young adolescents: A social network analysis. Cephalalgia 2020; 40:1321-1330. [PMID: 32635765 DOI: 10.1177/0333102420940700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The current study explored whether the chances of having migraine are influenced by a youth's friendship with a migraineur. METHODS The study was centered on a community-based non-referral cohort of eighth graders from two middle schools in Taiwan. Among the 642 recruited adolescent students, 610 (95%) (mean age 14.1 years, male ratio 51.2%) nominated three good friends and completed a validated headache questionnaire for migraine diagnosis at the follow-up survey 1 year later. To explore social influences on incident migraine, we used longitudinal statistical models to examine whether the development of migraine in one adolescent during the 1-year observational period was associated with that in his/her friends. RESULTS Overall, 1700 social ties were established in the social network based on the reported lists of good friends. Randomization test for the homophily effect demonstrated that the students with migraine tended to cluster together in the social network even when those with incident migraine were also considered (p = 0.003). Besides, when friendship choices were mutual, the relative risk of an adolescent becoming a migraineur was 3.26 (95% CI: 1.25-8.47, p = 0.015) if his/her friend became a migraineur (induction) during the 1-year observational period. CONCLUSION To the best of our knowledge, this is the first study to demonstrate that migraine may spread through social networks in young adolescents. Both homophily and induction effects are possibly contributory.
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Affiliation(s)
- Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Institute of Public Health, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Chun Chen
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shiang-Ru Lu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kai-Dih Juang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Psychiatry, Centro Hospitalar Conde de Sao Januario, Macau
| | - Shih-Pin Chen
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Feng Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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15
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Torres-Ferrús M, Ursitti F, Alpuente-Ruiz A, Brunello F, Chiappino D, de Vries T, Di Marco S, Ferlisi S, Guerritore L, Gonzalez-Garcia N, Gonzalez-Martinez A, Khutorov D, Kritsilis M, Kyrou A, Makeeva T, Minguez-Olaondo A, Pilati L, Serrien A, Tsurkalenko O, Van den Abbeele D, van Hoogstraten WS, Lampl C. From transformation to chronification of migraine: pathophysiological and clinical aspects. J Headache Pain 2020; 21:42. [PMID: 32349653 PMCID: PMC7189559 DOI: 10.1186/s10194-020-01111-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic migraine is a neurological disorder characterized by 15 or more headache days per month of which at least 8 days show typical migraine features. The process that describes the development from episodic migraine into chronic migraine is commonly referred to as migraine transformation or chronification. Ample studies have attempted to identify factors associated with migraine transformation from different perspectives. Understanding CM as a pathological brain state with trigeminovascular participation where biological changes occur, we have completed a comprehensive review on the clinical, epidemiological, genetic, molecular, structural, functional, physiological and preclinical evidence available.
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Affiliation(s)
- M. Torres-Ferrús
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute (VHIR), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F. Ursitti
- Headache Center, Child Neurology Unit, Bambino Gesu’ Children’s Hospital, Rome, Italy
| | - A. Alpuente-Ruiz
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute (VHIR), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F. Brunello
- Juvenile Headache Centre, Department of Woman’s and Child’s Health, University Hospital of Padua, Padua, Italy
| | - D. Chiappino
- Department of Internal medicine, Sant’Andrea Hospital, University of Rome, Sapienza, Italy
| | - T. de Vries
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S. Di Marco
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
| | - S. Ferlisi
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
| | - L. Guerritore
- Department of Internal medicine, Sant’Andrea Hospital, University of Rome, Sapienza, Italy
| | - N. Gonzalez-Garcia
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - A. Gonzalez-Martinez
- Neurology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - D. Khutorov
- Department of Clinical Neurology and Sleep Medicine, The Nikiforov Russian Center of Emergency and Radiation Medicine of EMERCOM of Russia, Saint-Petersburg, Russia
| | | | - A. Kyrou
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland University Hospital of Psychiatry, Bern, Switzerland
| | - T. Makeeva
- Headache Unit, Department of Neurology, Medical center “New Medical Technologies”, Voronezh, Russia
| | - A. Minguez-Olaondo
- Department of Neurology, Universitary Hospital of Donostia, San Sebastian, Spain
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Neurology, Hospital Quironsalud Donostia, San Sebastian, Spain
| | - L. Pilati
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
| | - A. Serrien
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - O. Tsurkalenko
- Department of Neurology and Neurosurgery, State Institution “Dnipropetrovsk medical akademy MOH Ukraine”, Dnipro, Ukraine
| | | | - W. S. van Hoogstraten
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - C. Lampl
- Headache Medical Center Linz, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - On behalf of School of Advanced Studies of European Headache Federation (EHF-SAS)
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute (VHIR), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Headache Center, Child Neurology Unit, Bambino Gesu’ Children’s Hospital, Rome, Italy
- Juvenile Headache Centre, Department of Woman’s and Child’s Health, University Hospital of Padua, Padua, Italy
- Department of Internal medicine, Sant’Andrea Hospital, University of Rome, Sapienza, Italy
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Neurology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Department of Clinical Neurology and Sleep Medicine, The Nikiforov Russian Center of Emergency and Radiation Medicine of EMERCOM of Russia, Saint-Petersburg, Russia
- Grevena General Hospital, Grevena, Greece
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland University Hospital of Psychiatry, Bern, Switzerland
- Headache Unit, Department of Neurology, Medical center “New Medical Technologies”, Voronezh, Russia
- Department of Neurology, Universitary Hospital of Donostia, San Sebastian, Spain
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Neurology, Hospital Quironsalud Donostia, San Sebastian, Spain
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurology and Neurosurgery, State Institution “Dnipropetrovsk medical akademy MOH Ukraine”, Dnipro, Ukraine
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Headache Medical Center Linz, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
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Headache Hygiene in Pediatrics: Brushing Up on the Basics. Pediatr Neurol 2020; 103:3-7. [PMID: 31843350 DOI: 10.1016/j.pediatrneurol.2019.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 01/18/2023]
Abstract
Headache hygiene refers to self-management behaviors and practices aimed at reducing headache-related disability and improving self-efficacy. Although self-management interventions have an established place in the management of a wide range of chronic conditions, there is still not a standardized approach to this in pediatric headache. In this article, we focus on headache hygiene approaches including education, lifestyle interventions, and psychologic interventions. We also present our center's resource compilation, made available to patients by quick response code technology, as an example of a structured approach to headache hygiene. Further work should explore a standardized approach to headache hygiene and strategies to support adherence, including the use of technology as an innovative health care delivery pathway.
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Hammond NG, Orr SL, Colman I. Early Life Stress in Adolescent Migraine and the Mediational Influence of Symptoms of Depression and Anxiety in a Canadian Cohort. Headache 2019; 59:1687-1699. [DOI: 10.1111/head.13644] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Nicole G. Hammond
- School of Epidemiology and Public Health University of Ottawa Ottawa ON Canada
| | - Serena L. Orr
- Department of Pediatrics University of Calgary Calgary AB Canada
| | - Ian Colman
- School of Epidemiology and Public Health University of Ottawa Ottawa ON Canada
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18
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Connelly M, Sekhon S. Current perspectives on the development and treatment of chronic daily headache in children and adolescents. Pain Manag 2019; 9:175-189. [PMID: 30681030 DOI: 10.2217/pmt-2018-0057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Headache disorders subsumed under the term chronic daily headache (CDH), including chronic migraine, chronic tension-type headache and new daily persistent headache, affect up to 4% of the pediatric population and can be highly disabling and challenging to effectively treat. Although historically the knowledge base about this group of headache disorders in children primarily was derived from clinical observation and extrapolation from adult studies, over the past several years there have been important research findings relevant to the development and management of pediatric CDH that can help inform clinical practice. The intent of this paper is to provide a focused review on recent empirical work done on pediatric CDH and suggest avenues for future work.
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Affiliation(s)
- Mark Connelly
- Department of Pediatrics, Division of Developmental and Behavioral Sciences, Children's Mercy Hospitals & Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Subhjit Sekhon
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64110, USA
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19
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Orr SL, Turner A, Kabbouche MA, Horn PS, O'Brien HL, Kacperski J, LeCates S, White S, Weberding J, Miller MN, Powers SW, Hershey AD. Predictors of Short-Term Prognosis While in Pediatric Headache Care: An Observational Study. Headache 2019; 59:543-555. [PMID: 30671933 DOI: 10.1111/head.13477] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To characterize the short-term prognosis of a clinical population of pediatric and young adult patients with migraine and explore predictors of clinical worsening while in care. METHODS This was a retrospective study of all migraine patients seen at the Cincinnati Children's Hospital Headache Center from 09/01/2006 to 12/31/2017, who had at least 1 follow-up visit within 1-3 months of the index visit analyzed. Included data were: age, sex, race, primary ICHD diagnosis, chronic migraine, medication overuse, history of status migrainosus, BMI percentile, headache frequency, headache severity, PedMIDAS score, allodynia, preventive treatment type, lifestyle habits, disease duration, depressive and anxiety symptoms. Clinical worsening was defined as an increase in 4 or more headache days per month between the index visit and the follow-up visit. RESULTS Data for 13,160 visit pairs (index and follow-up), from 5316 patients, were analyzed. Clinical worsening occurred in only 14.5% (1908/13,160), whereas a reduction in headache frequency was observed in 56.8% of visit intervals (7475/13,160), with 34.8% of the intervals (4580/13,160) showing a reduction of 50% or greater. The change in headache frequency was minimal (increase in 0-3 headaches/month) in 28.7% of intervals (3737/13,160). In the multivariable model, the odds of worsening were significantly higher with increasing age, female sex, chronic migraine, status migrainosus, depressive symptoms, higher PedMIDAS scores, and use of nutraceuticals, whereas the odds of worsening were lower for summer visits, caffeine drinkers, higher headache frequencies, and use of pharmaceuticals. CONCLUSIONS The majority of pediatric patients who receive multimodal interdisciplinary care for migraine improve over time. Our findings highlight a set of clinical features that may help in identifying specific factors that may contribute to an unfavorable short-term prognosis.
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Affiliation(s)
- Serena L Orr
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Abigail Turner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joanne Kacperski
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan LeCates
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shannon White
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica Weberding
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mimi N Miller
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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20
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Buse DC, Greisman JD, Baigi K, Lipton RB. Migraine Progression: A Systematic Review. Headache 2018; 59:306-338. [PMID: 30589090 DOI: 10.1111/head.13459] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Migraine is a common and often debilitating neurological disease. It can be divided into episodic and chronic subforms based on the number of monthly headache days. Because only a subset of individuals with episodic migraine (EM) progress to chronic migraine (CM) over any given time period, understanding the factors that predict the new onset of CM or "migraine progression" may provide insights into the mechanisms, pathophysiology, prevention, and treatment of CM. In this review, we identify and summarize studies that report risk factors associated with the new onset of CM or related chronic headache diagnoses, group these risk factors and report the strength of evidence for the identified risk factors. OBJECTIVE To conduct a systematic review of studies that identify risk factors for the new onset of CM or related chronic headache diagnoses such as transformed migraine (TM) and chronic daily headache (CDH). METHODS Herein we summarize the findings of studies of risk factors associated with the new onset of CM/TM, CDH, or related diagnoses from the English language literature published before March 2018. The PubMed database was searched for relevant studies. Longitudinal studies with follow-up data and case-control studies were included in this qualitative synthesis. We report methodology, analytic criteria, and results for each manuscript and for the parent study. Next, we review the strength of evidence for each of the identified risk factors using a modified version of AB Hill's criteria for causation and rank evidence as fair, moderate, or strong. We categorized risk factors as nonmodifiable, modifiable and based on putative mechanisms. We further categorized risk factors into sociodemographics, lifestyle factors and habits, headache features, comorbid and concomitant diseases and conditions and pharmacologic treatment-related. Finally, we review theories of the pathophysiology underlying the development of new onset chronic migraine or increasing attack frequency. RESULTS The PubMed search yielded 1870 records after duplicates were removed. Nine additional records were identified through expert consultation and other methods (eg, citations found as references in manuscripts identified in the literature review and through communication with the authors of manuscripts included in the review). The 1879 manuscripts were screened against the inclusion and exclusion criteria and 109 were found to be potentially eligible. Of 109 full-text articles, 17 studies were identified as meeting the prespecified criteria based on the consensus of all authors. Of the 17 full texts, 13 were longitudinal cohort studies and 4 were case-controlled studies. We found strength of evidence ranging from fair to strong for the identified risk factors. The strongest data were found for increased headache day frequency, depression, and medication overuse/high-frequency use. Risk factors for new onset CM and CDH in children and adolescents were similar to those identified in adults. CONCLUSIONS A range of risk factors for the new onset of CM/TM, CDH, or related chronic headache diseases were identified with the strongest data supporting increased headache day frequency, acute medication overuse/high-frequency use and depression, which are potentially modifiable risk factors. Modifiable risk factors may provide targets for intervention. The lack of strong evidence or any evidence does not imply that there is not a relationship between a particular risk factor and new onset CM or related disease; but may indicate little or no research or that research did not have sufficient methodological rigor. In addition, it is likely that additional risk factors exist which have not yet been identified. Putative factors include pro-inflammatory states and pro-thrombotic states. Development of central sensitization and increased activation of the trigeminal nociceptive pathways may be drivers of the new onset of CM or CDH. Future research may include the systematic testing of interventions targeting modifiable risk factors to determine if progression can be prevented as well as continued exploration of the benefits of treating these risk factors among people with CM in an effort to increase rates of remission. Future work should also consider the natural fluctuations in headache day frequency and examine progression in terms of continuous definitions rather than or in addition to a dichotomous boundary.
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Affiliation(s)
- Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jacob D Greisman
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Khosrow Baigi
- Department of Family Medicine, Bronx Care Health System, Bronx, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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21
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Orr SL, Kabbouche MA, O’Brien HL, Kacperski J, Powers SW, Hershey AD. Paediatric migraine: evidence-based management and future directions. Nat Rev Neurol 2018; 14:515-527. [DOI: 10.1038/s41582-018-0042-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
PURPOSE OF REVIEW The purpose of this work was to review the current literature on the epidemiology and pathophysiology of pediatric obesity and migraine, underlying pathogenic mechanisms that may explain the association between the two disorders, and the effects of treatment. RECENT FINDINGS In children and adolescents, the bulk of the available data support an association between obesity and headache disorders in general, though a small number of studies contradict these findings. Relative to the adult population, however, few studies have focused specifically on migraine, and no wide-ranging meta-analyses have been conducted to date. It seems that the pathophysiology of obesity and migraine in adults holds true for the pediatric population as well. The association between obesity and migraine in the pediatric population is likely to be multifactorial and to involve both central and peripheral mechanisms. More attention is currently being addressed to the role of the hypothalamus and the bioactive neurotransmitters and neuropeptides that modulate energy homeostasis, namely serotonin, orexin, and the adiponectins, in migraine. A few innovative studies have demonstrated some benefit for migraine from weight reduction treatments such as exercise and lifestyle management. Many open questions remain regarding the modifiable nature of the obesity-migraine relationship and its implications in clinical practice. Further studies of these issues are needed.
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Affiliation(s)
- Tal Eidlitz Markus
- Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Irene Toldo
- Juvenile Headache Centre, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
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Comorbidity of Migraine, Major Depressive Disorder, and Generalized Anxiety Disorder in Adolescents and Young Adults. Int J Behav Med 2018; 24:528-534. [PMID: 28032323 DOI: 10.1007/s12529-016-9620-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Depression and anxiety are highly comorbid psychiatric conditions and both are common in adult patients with migraine. This study aims to examine the unique associations between major depressive disorder (MDD) and generalized anxiety disorder (GAD) in a well-characterized group of older adolescents and college-age individuals with migraine. METHOD Participants (N = 227), between 15 and 20 years old, who were unmedicated or within 1 month of beginning antidepressant treatment underwent a comprehensive psychiatric assessment to establish the presence of MDD and GAD, according to the Diagnostic and Statistical Manual, Fourth Edition, Text Revision, and to rate their symptom severity using the Longitudinal Interval Follow-up Evaluation for Adolescents (A-LIFE). They then completed the ID-Migraine. The Student's t test and chi-square test were used to compare continuous and categorical variables, respectively, across participants with vs. without migraine. Logistic regression analysis examined the association between the presence of migraine and psychopathology. RESULTS A diagnosis of MDD was associated with significantly increased risk of having migraine. Moreover, more severe and persistent ratings of depression were associated with an even higher likelihood of having migraine. A diagnosis of GAD was also significantly associated with the presence of migraine. The prevalence of comorbid MDD and GAD was significantly higher in participants with migraine than those without migraine (55 vs. 22%, p < 0.0001). When examined concurrently, GAD remained significantly associated with migraine, with a statistical trend for MDD to be associated with it. CONCLUSION The comorbidity of migraine, MDD, and GAD has important clinical and research implications. Patients who suffer from any of these problems should be screened for all three in order to receive comprehensive care. Shared psychological and biological vulnerabilities may be involved in the three conditions. Greater understanding of the shared vulnerabilities can lead to unified treatments.
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Pan YJ, Juang KD, Lu SR, Chen SP, Wang YF, Fuh JL, Wang SJ. Longitudinal risk factors for suicidal thoughts in depressed and non-depressed young adolescents. Aust N Z J Psychiatry 2017; 51:930-937. [PMID: 28701051 DOI: 10.1177/0004867417717795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Evidence regarding the role of risk factors in the longitudinal course of suicidal ideation among young adolescents is lacking. We aimed to assess the effects of a range of risk factors, including obesity, academic performance, child-parent relationship, physical maltreatment, and depressive symptoms, on the development of suicidal ideation in young adolescents. METHODS A school cohort of seventh and eighth graders was followed for 1 year and differences in the risk factors distributions were examined between depressed and non-depressed adolescents. We further examined risk factors for newly developed suicidal ideation and persistent suicidal ideation in the groups of adolescents based on the presence of suicidal ideation at baseline. RESULTS A total of 1710 young adolescents were recruited, among whom 8.2% were categorised as having clinically significant depression. For depressed adolescents, being obese was associated with a three-fold increased risk of having suicidal ideation. For non-depressed adolescents, physical maltreatment, a feeling of not being cared about and sub-threshold depressive symptoms were the risk factors. The latter two remained robust in predicting newly developed suicidal ideation. CONCLUSION The current study may shed light on the differential strategies to address suicidal thoughts in depressed and non-depressed adolescents. We emphasise the importance of recognition and management of sub-threshold depressive symptoms and the relevance of obesity, physical maltreatment and a feeling of not being cared about to suicide prevention programmes in early adolescence.
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Affiliation(s)
- Yi-Ju Pan
- 1 Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Dih Juang
- 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,3 Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shiang-Ru Lu
- 4 Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Pin Chen
- 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,5 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Feng Wang
- 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,5 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jong-Ling Fuh
- 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,5 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,5 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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Fife B, Forste R. Physical and social factors associated with early adolescent headache and stomachache pain. Int J Adolesc Med Health 2016; 30:/j/ijamh.ahead-of-print/ijamh-2016-0062/ijamh-2016-0062.xml. [PMID: 27665418 DOI: 10.1515/ijamh-2016-0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/14/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Approximately one third of adolescents in the United States report experiencing frequent headaches and stomachaches. We examined the association of psychosocial and physical factors with the report of weekly headaches or stomachaches using a representative sample of US teens. METHODS Data for this project are from the survey of Health Behavior in School-Aged Children (HBSC), 2005-2006, a nationally representative sample of students in grades 6-10 in the United States. The total sample includes 12,070 students aged 11-17. Using logistic regression we modeled chronic headache and stomachache separately with the same set of physical predictors (dieting and substance use habits) and psychosocial predictors (attitudes towards self-image, peers, and family) along with demographic controls. RESULTS Almost 20% of respondents experienced headaches weekly, and 12% experienced abdominal pain. Both physical and psychosocial factors were predictive of chronic symptoms. Increased substance usage and unhealthy eating practices were associated with the likelihood of experiencing both headaches and stomachaches. Negative self-image, family relationships, and school life were also predictive of symptom frequency. CONCLUSION Headaches and stomachaches are associated with poor eating and substance use habits, as well as problems with self-image or social relationships among adolescents. For health care professionals, a holistic approach is needed to effectively address symptoms and prevent long-term health problems.
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Affiliation(s)
- Benjamin Fife
- Department of Sociology, Brigham Young University, Provo, UT,United States of America
| | - Renata Forste
- Department of Sociology, Brigham Young University, Provo, UT,United States of America
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Child and Family Antecedents of Pain During the Transition to Adolescence: A Longitudinal Population-Based Study. THE JOURNAL OF PAIN 2016; 17:1174-1182. [PMID: 27497769 DOI: 10.1016/j.jpain.2016.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/06/2016] [Accepted: 07/26/2016] [Indexed: 11/21/2022]
Abstract
Pediatric persistent pain is associated with poorer physical and psychosocial functioning in children, as well as immediate and long-term societal costs. Onset typically occurs in early adolescence, suggesting that late childhood is a key window for identifying potential intervention targets before pain symptoms become entrenched. This study used population-based data from the Longitudinal Study of Australian Children (n = 3,812) and adopted a biopsychosocial and ecological systems approach to investigate child, family, and sociodemographic factors associated with pain problems in children transitioning to adolescence. The prevalence of at least weekly parent-reported pain in the study sample was approximately 5% at 10 to 11 years of age, and pain continued at 12 to 13 years of age for 40% of these children. Key factors at 10 to 11 years that uniquely predicted parent-reported pain problems at 12 to 13 years were frequency of previous pain (1-3 times weekly: odds ratio [OR] = 7.49; 95% confidence interval [CI], 4.3-13.0; 4-7 times weekly: OR = 17.8; 95% CI, 8.7-36.5) and sleep difficulties (OR = 1.86; 95% CI, 1.16-2.97). This study highlights the importance of early intervention for persistent pain in childhood, because pain complaints in late childhood tend to persist into early adolescence. PERSPECTIVE This article used a biopsychosocial and ecological systems approach to understanding predictors of pain problems during the transition to adolescence within a nationally representative community-based cohort. Sleep difficulties at 10 to 11 years uniquely predicted pain at ages 12 to 13 years, suggesting that early intervention using sleep interventions may be a promising direction for future research.
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Systematic Review of Childhood and Adolescent Risk and Prognostic Factors for Recurrent Headaches. THE JOURNAL OF PAIN 2016; 17:855-873.e8. [DOI: 10.1016/j.jpain.2016.03.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/18/2016] [Accepted: 03/15/2016] [Indexed: 11/24/2022]
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Gofshteyn JS, Stephenson DJ. Diagnosis and Management of Childhood Headache. Curr Probl Pediatr Adolesc Health Care 2016; 46:36-51. [PMID: 26750538 DOI: 10.1016/j.cppeds.2015.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
Headache is one of the most common chief complaints seen in the pediatrician's office. Oftentimes, identifying the etiology of headache and differentiating primary and secondary causes can present a diagnostic conundrum. Understanding the most common causes of primary and secondary headache is vital to making a correct diagnosis. Here we review the typical presentations of the most common primary headache disorders and the approach to evaluation of the pediatric patient presenting with headache. Diagnostic workup, including the key features to elicit on physical examination, when to order head imaging, and the use of other ancillary tests, is discussed. Current treatment modalities and their indications are reviewed. We will also describe some of the new, emerging therapies that may alter the way we manage headache in the pediatric population. Headache can, at times, be a frustrating symptom seen in the pediatrician's office, but here we hope to better elucidate the approach to evaluation, management, and treatment as well as provide some hope in regards to more effective upcoming therapies.
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Affiliation(s)
| | - Donna J Stephenson
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA.
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Abstract
Chronic daily headache (CDH) is a group of headache disorders, in which headaches occur daily or near-daily (>15 days per month) and last for more than 3 months. Important CDH subtypes include chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Other headaches with shorter durations (<4 h/day) are usually not included in CDH. Common comorbidities of CDH are medication overuse headache and various psychiatric disorders, such as depression and anxiety. Indications of inpatient treatment for CDH patients include poor responses to outpatient management, need for detoxification for overuse of specific medications (particularly opioids and barbiturates), and severe psychiatric comorbidities. Inpatient treatment usually involves stopping acute pain, preventing future attacks, and detoxifying medication overuse if present. Multidisciplinary integrated care that includes medical staff from different disciplines (e.g., psychiatry, clinical psychology, and physical therapy) has been recommended. The outcomes of inpatient treatment are satisfactory in terms of decreasing headache intensity or frequency, withdrawal from medication overuse, reducing disability, and improving life quality, although long-term relapse is not uncommon. In conclusion, inpatient treatment may be useful for select patients with refractory CDH and should be incorporated in a holistic headache care program.
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Abstract
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.
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Abstract
Chronic daily headache (CDH) is a common neurological condition that affects 1-4 % of the general population. Most individuals with CDH originally suffered from episodic headaches, but over time, this developed into CDH. Although the pathophysiology of CDH is not fully understood, recent clinical and epidemiological studies suggest some risk factors that are associated with an increased risk of transformation from episodic headaches. If risk factors can be identified, they could provide a base for aggressive preventive intervention and thus decrease the transformation from episodic headaches to eventual CDH. In this article, we review and summarize the current data on risk factors for CDH.
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Affiliation(s)
- Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
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Abstract
Sleep and headache have a complex and extensive interrelationship. This review focuses on the relationship between sleep and chronic daily headache, examining recent advances in the epidemiology and insights into possible mechanisms of this relationship as well as reviewing advances in treatment. There is a clear relationship between obstructive sleep apnoea (OSA) and snoring and morning headache, but the relationship between OSA and snoring and other primary headaches requires clarification. OSA and chronic migraine share both obesity and patent foramen ovale (PFO) as possible co-morbidities. Hypoxia does not clearly predispose to morning headache. Continuous positive airway pressure (CPAP) is an established treatment for OSA, and mixed results have been reported with regards to headache improvement with this treatment.
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Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society. Acta Neurol Belg 2015; 115:1-17. [PMID: 24968722 DOI: 10.1007/s13760-014-0313-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/13/2014] [Indexed: 12/24/2022]
Abstract
Chronic migraine (CM) is a disabling neurological condition affecting 0.5-2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse is no longer an exclusion criterion and CM is diagnosed in patients suffering from at least 15 headache days per month of which at least eight are related to migraine. CM is difficult to treat, and preventive treatment options are limited. We provide a pathogenetic model for CM, integrating the latest findings from neurophysiological and neuroimaging studies. On behalf of the Belgian Headache Society, we present a management algorithm for CM based on the international literature and adapted to the Belgian situation. Pharmacological treatment options are discussed, and recent data on transcranial and invasive neuromodulation studies in CM are reviewed. An integrated multimodal treatment programme may be beneficial to refractory patients, but at present, this approach is only supported by a limited number of observational studies and quite variable between centres.
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Abstract
Primary headaches among children and adolescents have a substantial impact on quality of life, daily activities, social interaction, and school performance in combination with psychopathological symptoms. The main purpose of the present paper is to summarize clinical and epidemiological evidence for psychiatric comorbidity among children and adolescents with headaches, to describe how evidence in headache research suggest different pathways involved in the development and maintenance of these comorbid conditions, and finally suggest some elements professionals may find helpful to assess the scope of complaints, related functional impairment, and potential precipitating factors in planning of more targeted treatments.
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Affiliation(s)
- Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, P.B. 181, Nydalen 0409, Oslo, Norway,
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Abstract
Childhood obesity and headache are both significant health concerns that often have a marked impact both personally and socially, that if not addressed can carry over into adulthood. For many individuals, these effects may be magnified when obesity and headache are seen in conjunction. It is this overlap between obesity and headache in children, as well as similarities in the known mechanism of action for feeding and headache, which led to a suspected association between the two. Unfortunately, although recent studies have supported this association, only a limited number have been conducted to directly address this. Furthermore, despite rising rates of childhood obesity and headache, the associated medical comorbidities, and the significant financial cost for these conditions, there is a relative void in studies investigating treatment options that address both underlying conditions of obesity and headache in children.
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Abstract
OBJECTIVE The current study provides the first measure of pain-related fear for pediatric headache patients. METHODS From a large pediatric headache clinic, a cross-sectional cohort of 206 children and adolescents completed measures of pain-related fear, anxiety sensitivity, catastrophizing, pain acceptance, functional disability, and school functioning. RESULTS The two-factor solution of the Fear of Pain Questionnaire (FOPQ) was confirmed from the originally derived structure with pediatric headache patients. Simultaneously regressing FOPQ subscales fear of pain and activity avoidance on theorized construct validity measures demonstrated that fear of pain was more closely linked with anxiety sensitivity and pain catastrophizing while activity avoidance had a strong negative association with pain acceptance (activity engagement and pain willingness). Pain-related fear was not significantly associated with pain level. After controlling for demographic factors and pain, fear of pain and activity avoidance accounted for an additional 26% of the variance in functional disability and school functioning outcomes, with activity avoidance accounting for much of this relationship. CONCLUSIONS Although typically considered an influential construct among musculoskeletal patients, pain-related fear is also an important factor influencing functioning among pediatric headache patients, with the dimension of activity avoidance particularly salient.
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Affiliation(s)
- Laura E Simons
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA Department of Psychiatry, Harvard Medical School, MA, USA
| | - Melissa Pielech
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA
| | - Stefanie Cappucci
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA
| | - Alyssa Lebel
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA
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Millichap JG. Chronic Daily Headache in Young Adolescents. Pediatr Neurol Briefs 2013. [DOI: 10.15844/pedneurbriefs-27-9-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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