Primary Headaches in Children: Clinical Findings and the Association with other Conditions

Abstract

The aim of the present study is to report on the frequency of some comorbidities in primary headaches in childhood. Two hundred and eighty children (175 males and 105 females; ratio 1.7:1), aged 4 to 14 years, affected by primary headaches were consecutively enrolled in this study. In direct interviews, parents and children gave information about the association of their headaches with different conditions including asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight, affections some time associated in the literature to headache as comorbidities . In addition, anxiety and depression, attention deficitlhyperactivity disorder, tics, learning disabilities and obsessive-compulsive disorders, using psycho-diagnostic scales were evaluated. Two hundred and eighty children matched for age, sex, race and socio-economic status; were used as controls. No significant association of primary headaches was found with asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight. Overall behavioral disorders were more common in children who experienced headache than in controls. A significant association of primary headache was found with anxiety and depression (p value <0.001), but not with the other psychiatric disorders. Primary headaches in children are not associated with most of the psychiatric and systemic conditions herein investigated. On the contrary, there was a significant association with anxiety and depression, as frequently reported in adults.Recurrent headaches are very widespread and disabling conditions in children. Although most cases follow a benign course, they cause substantial worry in parents and caregivers. The diagnosis of primary and secondary headache disorders is based upon the history of headaches, a careful physical and neurological examination, and in some cases, neurological investigations.Recurrent, episodic and paroxysmal attacks are suggestive of primary headache disorders, which have been subdivided into migraines, tension-type headaches (TTHs), cluster headaches, and other (uncommon) types in children. Migraines are further subdivided into migraines with and without auras, complicated migraines and migraine variants (1-3). Migraines have been estimated to affect nearly 75% of children under the age of 15 years and have been reported in 3.9% of children between the ages of 7 and 15 years, with a range from 1.7% in 7-yearold children to 5% in l5-year-old children (3-4).

Sleep and Chronic Daily Headache

“…Children with primary headache were examined for comorbidities including sleep disturbance by Pavone et al They found no association with sleep disorders or obesity although there was a significant association with depression and anxiety [20].…”

Headache and comorbidity in pediatric age

“…Moreover, migraineurs have a higher prevalence of anxiety/depression than controls [7,8]. Severity of anxiety/depression is linked with severity and frequency of migraine [9].…”

Temperamental characteristics in childhood migraine without aura: a multicenter study

“…According to this definition, the results of the present study showed a reduction in the MoA children of the SD domain SD correlated negatively with frequency, intensity, and duration of attacks; this could pinpoint the role of migraine in the development of different character styles. Recently, overall behavioral disorders have been reported as more common in children who experienced headache than in controls 12,56…”