Children and adolescents often experience headaches while growing up and Migraine and tension-type headache (TTH) seem to be the most common. With the high frequency of primary headache disorders in this population, there is little understanding the pathophysiology of them, or how they may progress into adult Migraine and headache disorders. Moreover, certain characteristics found in childhood Migraine and headache and those that aren't typically found in adults, as well as their emotional and psychological development need to be corroborated. Dr. Andrew Hershey, director of the Headache Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, has complied updated research on pediatric Migraine and headache.
The gold standard doctors use to diagnose Migraine and headache disorders is the International Headache Society's International Classification of Headache Disorders, 2nd Edition (ICHD-II) which is now being amended. A problem arises when trying to diagnose child or adolescent Migraine, since the ICHD-II doesn't list the finer points in this area. There are however, some footnotes for specific diseases that affect only this age group. In one study, using ICHD-II, just 61.9% were able to be accurately diagnosed for childhood and adolescent Migraine. ICDH-II is helpful, but doesn't cover enough ground to completely comprehend these disorders. It seems, according to Dr. Hershey, this isn't a problem in the clinical setting. However in when it comes to research, without a better picture of pediatric Migraine and headache, it's difficult to study the science and epidemiology and look for new treatments for these disorders.
It's also been established that beginning at an early age, some children may experience episodic conditions linked with Migraine. Three of these disorders are abdominal Migraine, benign paroxysmal vertigo and tension-type headache aka TTH. Also a growing area of scientific research in childhood and adolescent Migraine and headache and comorbid conditions. Abuse, blood pressure, epilepsy and psychological issues may all have direct impact on Migraine and headache disorders in adolescents and children. "Abuse" when used in study methods, was defined as emotional, physical, or sexual molestation; substance abuse, living in a household with domestic violence and/or mental illness, family members who were criminals and divorce. Children who suffered abuse also were more likely to be depressed, have a lower emotional ability and experienced more severe and frequent pain.
Historically in adults, there has been an opposing connection between headache and high blood pressure. It seems that the same holds true for children and adolescents for both TTH and frequent headache, but not Migraine for systolic blood pressure according to one study. Researchers don't fully understand the pathophysiology, but more work needs to be done in the venue which may help improve the choices of preventive medications.
Epilepsy and Migraine have already been established as comorbid conditions in adults. Through limited studies, there have been comparable links found in children and adolescents. Small studies have indicated children who suffered both headache and epilepsy with Migraine had them 3.2 times more often then those subjects with TTH. Another small study of 75 subjects with juvenile myocyclonic epilepsy (JME) revealed patients with JME had a 4.4 times greater risk in having Migraine; 3.6 times greater for Migraine without aura; 7.3 times greater for Migraine with aura and had TTH at the rate of 3.4 times more than the general population.
Children and adolescents who had Migraine with or without TTH seemed to have higher chronic stress levels. Chronic stress was defined as work overload, work discontent, social stress, lack of social recognition, worries, and intrusive memories. Children who had headache with behavioral and emotional issues reported having more anxiety. This information may indicate that coping with life's stressors should be discussed and that emotions may be an "early contributor" to childhood headache.
A United States study explored the incidence and burden of chronic daily headache in adolescents using a variety of methods; questionnaires sent in the mail, interviews by phone and a voice response diary. They found:
- 1.75% of this age group (12-17 year olds) had chronic Migraine and over half of them were overusing pain medication.
- When researchers removed overuse of medication, the chronic Migraine number decreased to 0.79%.
- 76.3% of this population with 15 headache days or more a month didn't meet the standards for chronic Migraine or chronic TTH.
- 27.5% of those with headache on more than 15 days a month were overusing medication; 48.1% overused ibuprofen; 21.5% overused acetaminophen.
- Prescription use for preventive or abortive therapies was unlikely and those who had chronic Migraine were more disabled.
Studies from various other countries reported over three quarters of adolescents with Migraine had their lives affected in a negative ways; missing school, the inability to carry out home duties and outside activities. This same population was able to report their triggers including lack of sleep, hunger, stress and photophobia. Another study showed that children with Migraine, especially girls, were more likely to have depressive and/or anxiety symptoms along with poor sleep hygiene. And those with primary headache had a much bigger link with periodic symptoms of cyclic vomiting, abdominal Migraine, paroxysmal vertigo and recurrent abdominal pain.
We are discovering that primary headache may begin in childhood. Each phase of development a child goes through may bring an increase in headache progression. It is pretty clear that early recognition and intervention is imperative because pain shifts in this age group over time.
The recent research in childhood and adolescents Migraine and primary headache is starting to unravel changes at a physiological and molecular level. This information builds on the premise that primary headache disorders and Migraine are neurological conditions, and this information will continue to help us understand them and look for treatment.
Hershey, Andrew. M.D., Ph.D. "Pediatric Headache: Update on Recent Research." Headache. 2012;52:327-332.
Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders 2nd Edition, 1st Revision." Cephalalgia 2004;24:8-160. "Benign paroxysmal vertigo of childhood."
Epilepsy Therapy Project. "Juvenile Myoclonic Epilepsy: Characteristics and Treatment."
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© HealthCentral Network, 2012.
Last updated February 14, 2012.
Published On: February 14, 2012