The purpose of this study was to determine the prevalence, sociodemographic correlates, and comorbidity of recurrent headache in children in the United States. Participants were individuals aged 4 to 18 years (n = 10 198) who participated in the National Health and Nutrition Examination Surveys. Data on recurrent and other health conditions were analyzed. Frequent or severe headaches including migraine in the past 12 months were reported in 17.1% of children. Asthma, hay fever, and frequent ear infections were more common in children with headache, with at least 1 of these occurring in 41.6% of children with headache versus 25.0% of children free of headache. Other medical problems associated with childhood headaches include anemia, overweight, abdominal illnesses, and early menarche. Recurrent headache in childhood is common and has significant medical comorbidity. Further research is needed to understand biologic mechanisms and identify more homogeneous subgroups in clinical and genetic studies. Keywordsheadache; migraine; comorbidity; prevalence Headache is a common complaint in children and adolescents. The most frequent type of recurrent headache in young children is migraine, 1 while the frequency of tension type headache increases in the later years of childhood. Recurrent headaches can negatively impact a child's life in several ways, including school absences, decreased academic performance, social stigma, and impaired ability to establish and maintain peer relationships. The quality of life in children with migraine is impaired to a degree similar to that in children with arthritis or cancer. 2 There has been limited population-based research on headache and migraine in children, particularly in the United States. Most of our knowledge regarding the prevalence and demographic correlates of migraine is derived from school-based questionnaire studies in European countries [3][4][5][6] and some from the United States. 7,8 Prevalence estimates for headache in prepubertal children range from 2.4% to 17% for migraine and 4% to 5% for frequent or severe headache. For the postpubertal ages estimates are considerably higher, ranging from NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript 5% to 18% for migraine and 9% to 29% for other frequent or severe headaches. Despite the impact of headache on pediatric health, only 1 population-based American study to date has examined the frequency of recurrent headache in children. 9 Individuals who suffer from migraine or severe headaches are also diagnosed with certain other medical conditions at a higher than expected frequency. Comorbidity can significantly influence the delivery of medical care as it may confound diagnosis and provide special therapeutic challenges. No population-based study to date has systematically examined the patterns of medical comorbidity of recurrent headache or migraine in childhood. Knowledge of other biologic systems involved would not only help physicians provide better care for their patients but may also ...

To examine patterns of associations between a broad range of mental and physical conditions by using a large, systematically obtained pediatric registry.

Adults with severe headache are at significantly higher risk of also suffering from sleep problems, when compared with the general population, regardless of specific headache type. Optimal treatment of headache must include investigation for sleep disorders and vice versa.

For young children presenting to the ED with headache but normal neurologic examination findings and nonworrying history, CT scans seldom lead to diagnosis or contribute to immediate management.

Background Evidence regarding associations of headache with other somatic conditions in children has been largely based on clinical samples. The objective of this study was to examine the pattern and extent to which other physical conditions are comorbid with migraine and other headaches among youth in a representative sample of the US population. Methods The National Comorbidity Survey-Adolescent Supplement (NCS-A) is a face-to-face survey of adolescents aged 13–18 years in the continental United States. Sufficient information to assess the International Headache Society criteria for Migraine with and without Aura over past 12 months was available in the diagnostic module. A caretaker/parental self-administered report (PSAQ) was used to assess a broad range of other physical conditions. The sample for these analyses included 6843 adolescents with systematic caretaker/parent reports. Results Individuals with any headaches reported higher rates of other neurologic conditions such as epilepsy (OR 2.02 [95% CI: 1.04–3.94]), persistent nightmares (OR 2.28 [95% CI: 1.34–3.87]), and motion sickness (OR 1.6 [95% CI: 1.07–2.4]), as well as abdominal complaints (OR 2.36[95%CI: 1.59–3.51]). Adolescents with migraine more often reported asthma (OR 2.22 [95% CI: 1.26–3.92]) or seasonal allergies (OR 1.66 [95%CI: 1.12–2.48]) compared to those with non-specific headache. Conclusions Adolescent migraine is associated with inflammatory conditions such as asthma and seasonal allergies, and with epilepsy, persistent nightmares and motion sickness. Findings suggest that comorbid medical conditions should be evaluated comprehensively in determining treatment options in youth with headache. Such comorbidity could also be an important source of clinical and etiologic heterogeneity in migraine.

The aim of this article is to assess the concordance between parent and adolescent headache ratings in a representative sample of 6483 US adolescents (aged 13–18 years). Headaches were assessed using modified criteria from the International Headache Society's International Classification of Headache Disorders, Second Edition. Caregiver report was based on a self-administered questionnaire. Overall concordance between caregivers and adolescents on the presence or absence of headaches was quite low (κ = 0.39). Female caregivers were twice as likely as male caregivers to report headaches in their offspring. Positive endorsement of headaches in offspring by caregivers was associated with adolescent-reported chronic headaches, longer headache duration, and photophobia or phonophobia. These findings suggest that relying solely on parent report may result in an underestimate of the true prevalence of headaches in the general population. In addition, collecting information from both parents and adolescents could be critical to effective treatment and prevention of the severe consequences of migraine.

Background There is limited research on the association of sleep problems with International Classification of Headache Disorders (ICHD-II)-defined headache subtypes in youth, particularly from community-based samples. This cross-sectional study examines the associations of sleep patterns, symptoms and disorders with specific headache subtypes among adolescents from the general population of the United States. Methods The sample includes 10,123 adolescents in the National Comorbidity Survey – Adolescent Supplement, a face-to-face survey of adolescents aged 13–18 years in the continental USA. Headache subtype diagnoses were based on modified ICHD-III criteria, and mood and anxiety disorders were based on Diagnostic and Statistical Manual of Mental Disorders criteria. The associations of self-reported sleep patterns and insomnia symptoms and headache status were estimated with multivariate regression models that adjust for demographic characteristics and comorbid anxiety and mood disorders. Results There was no significant difference in bedtime between youth with and without headache. However, adolescents with migraine headache reported significantly shorter sleep duration ( p = .022) and earlier wakeup time ( p = .002) than those without headache. Youth with any headache, particularly migraine, had significantly more sleep disturbances than those without headache. With respect to headache subtypes, youth with migraine with aura were more likely to report difficulty maintaining sleep, early morning awakening, daytime fatigue, and persistent insomnia symptoms than those with migraine without aura. However, these associations were largely accounted for by comorbid anxiety and mood disorders. There was a monotonic increase in the number of insomnia symptoms with increasingly restrictive definitions of migraine. Conclusion Pervasive sleep disturbances in adolescents with headache have important implications for the evaluation, treatment and etiology of pediatric headache.

Understanding patterns of medical comorbidity in attention-deficit/hyperactivity disorder (ADHD) may lead to better treatment of affected individuals as well as aid in etiologic study of disease. This article provides the first systematic evaluation on the medical comorbidity of ADHD in a nationally representative sample (National Comorbidity Replication Survey-Adolescent Supplement; N = 6483) using formal diagnostic criteria. Survey-weighted odds ratios adjusted for demographics, additional medical, and mental disorders were calculated for associations between ADHD and medical conditions. Models adjusted for demographics revealed significantly increased odds of allergy, asthma, enuresis, headache/migraine, and serious stomach or bowel problems. After adjusting for comorbidity, across the medical conditions, enuresis and serious stomach problems were the strongest correlates of ADHD. These findings confirm the pervasive medical comorbidity of ADHD reported in previous clinical and community-based studies. The intriguing salience of enuresis and serious stomach or bowel conditions may also provide an important clue to multisystem involvement in ADHD.