<p>Nonpharmacological Interventions Addressing Pain, Sleep, and Quality of Life in Children and Adolescents with Primary Headache: A Systematic Review</p>

Abstract

Purpose: Children and adolescents with primary headache are at risk of persistent somatic symptoms and reduced quality of life (Qol) due to pain and pain-related behaviors, such as avoiding school and activities. Sleep is essential to health, and children and adolescents with primary headaches have more sleep complaints than do healthy controls. A treatment approach that addresses multifactorial causes is likely important. Nonpharmacological interventions seem promising. However, knowledge about effective strategies is limited. The objective of this review is to assess the effect of nonpharmacological interventions in randomized controlled trials (RCTs) among children and adolescents with primary headache in order to identify useful strategies. Patients and methods: Outcome measures are pain, sleep, Qol, and coping versus no intervention or control intervention. Medline, CINAHL, EMBASE, and PsycINFO were searched for eligible trials. ClinicalTrials.gov. was searched for ongoing trials. Initial searches yielded 2588 publications. After initial screening and subsequent full-text review and quality assessment, 13 RCTs reported in 15 articles were selected for review. All reviewers independently assessed study quality using the CONSORT criteria for nonpharmacological interventions. Results: Cognitive behavioral therapy (CBT), including education on pain-related topics, sleep, coping, and stress management, is an effective strategy for reducing headache and pain within groups over time. Fifteen studies assessed pain, 3 studies assessed sleep, 6 studies assessed Qol, and 11 studies assessed coping. Conclusion: Strategies identified as useful were parts of CBT interventions. However, it was not possible to identify a single effective intervention addressing pain, sleep, Qol, and coping in children and adolescents with headache, primarily because sleep was infrequently addressed. Various aspects of Qol and coping strategies were assessed, rendering comparison difficult. Strategies for future interventions should include descriptions of theory-driven CBT interventions, depending on clinical setting and based on local resources, to promote a solid evidence base for nonpharmacological interventions.

Burden of disease and lifestyle habits in adolescents and young adults prone to frequent episodic migraine: A secondary comparative analysis

“…This study reflects a lower duration of sleep during weekdays and a lower level of general physical activity in the adult group. Sleep hygiene (i.e., regular sleeping patterns and adequate duration of sleep [in general >8 h per night]) and general physical activity strongly correlate with the burden of headache disorders and are an integral part of any migraine education program ( Fernandez-de-Las-Penas et al, 2010 ; Fernandez-de-Las-Penas et al, 2018 ; Klausen et al, 2019 ; Molarius et al, 2008 ; Pavkovic and Kothare, 2020 ; Robberstad et al, 2010 ; Rosenberg et al, 2018 ; Roy et al, 2019 ; Solotareff et al, 2017 ; Torres-Ferrus et al, 2019 ).…”

“…Mutual outpatient hours held by child neurologists together with neurologists for patients in their late teen and early twen years could ease transition to adult neurology. Appealingly designed educational material and distribution of information via different kinds of media may represent further key features ( Albers et al, 2015a ; Klausen et al, 2019 ; Kroon Van Diest et al, 2016 ). With regard to lifestyle management, the significance of a well-balanced diet, sleep habits, and physical activity should be addressed.…”

Sleep Health Assessment and Treatment in Children and Adolescents with Chronic Pain: State of the Art and Future Directions

“…A recent systematic review by Klausen et al, [ 54 ] found that sleep was reported as a treatment outcome in only two published RCTs of CBT-Pain in pediatric samples [ 55 , 56 ]. Sleep assessments included a self-report measure of sleep quality [ 56 ] and seven days of actigraphy monitoring [ 55 ].…”

Sugar-Sweetened Beverages and Symptom Complaints among School-Aged Children: A National Longitudinal Study

“…According to a German study, clinical symptom complaints are common among school-aged children [ 4 ]. Another study indicated that symptoms such as medically unexplained abdominal pain and headache contributed to more than half of school absences [ 5 ], highly impacting academic performance [ 6 ]. It is unclear how these medically unexplained symptoms occurred, but diet advice may affect medically unsolved symptoms in childhood [ 7 ], indicating that these symptoms could be related to food.…”