'Let's Move!' to Decrease the Risk of Headaches in Children and Adolescents
'Let's Move!' to Decrease the Risk of Headaches in Children and Adolescents
Abstract & Commentary
By Dara Jamieson, MD, Associate Professor of Clinical Neurology, Weill Cornell Medical College. Dr. Jamieson reports she is a retained consultant for Boehringer Ingelheim, Merck, and Ortho-McNeil, and is on the speaker's bureau for Boehringer Ingelheim and Merck.
Synopsis: Migraine headaches are more common than tension-type headaches in children and adolescents. Being overweight, smoking, and being sedentary are associated with recurrent migraine and tension-type headaches in adolescents.
Sources: Arruda MA, et al. Frequency of headaches in children is influenced by headache status in the mother. Headache 2010;50: 973-980. Arruda MA, et al. Primary headaches in childhooda population-based study. Cephalalgia 2010;30:1056-1064. Robberstad L, et al. An unfavorable lifestyle and recurrent headaches among adolescents: The HUNT Study. Neurology 2010;75:712-717. Hershey AD, Lipton R. Lifestyles of the young and migrainous. Neurology 2010;75:680-681.
Children and adolescents get frequent headaches, more commonly migraines than tension-type headaches (TTH). Arruda et al estimated the prevalence and frequency of primary headaches in 1994 pre-adolescent children (aged 5-12 years) using a questionnaire with classification of headaches using the criteria of the second edition of the International Classification of Headache Disorders. The overall prevalence of migraine was 3.76% (boys: 3.9%; girls: 3.6%). Prevalence of probable migraine was 17.1%. Pooling migraine and probable migraine, the prevalence of episodic headaches with migraine features was 22.3% in girls and 19.4% in boys. Episodic TTH was less common in children than migraine, with infrequent episodic TTH in 2.3% and frequent episodic TTH in 1.6%. The study found that 13.5% of children had probable TTH. The data from the study also were used to determine that the frequency of headaches in the mother predicted the frequency of headaches in the children. When the mother had low frequency headaches, the children had an increased chance to have low or intermediate headache frequency (relative risk = 1.4, 1.2-1.6). When the mother had chronic daily headache (CDH), the risk of CDH in the children was increased by almost 13-fold, but the risk of infrequent headaches was not increased. Headaches in the children were independently predicted by headaches in the mother (P < 0.001); headache frequency in the children also was predicted by frequency in the mother (P < 0.001).
Robberstad et al examined the relationship between recurrent headache disorders (i.e., migraine and TTH) and lifestyle factors (overweight, low physical activity, and smoking) in an unselected population study of adolescents. From August 1995 to June 1997, all junior high school and high school students in Nord-Trøndelag County in Norway were invited to participate in the youth part of the Nord-Trøndelag Health Study (Helseundesøkelsen I Nord-Trøndelag; HUNT). In the HUNT study, 5,847 adolescents aged 13 to 18 years were interviewed about headache complaints during a clinical examination performed at the schools. Trained nurses performed the headache interviews and the students were asked whether they had experienced recurrent headaches during the past 12 months. The students were given descriptions to classify typical recurring headache symptoms into migraine, TTH, or non-classifiable headache categories. Headache frequency was recorded. Physical activity, smoking, body mass index determination of being overweight or obese, and overall health (lifestyle factor) status were determined by a comprehensive health habits questionnaire. Adolescents with high physical activity who were not current smokers and not overweight were classified as having a good lifestyle status. These students were compared to those with one or more of the negative lifestyle factors. When considering lifestyle status based on the combination of weight, level of physical activity, and smoking status, intermediate, poor, and very poor lifestyle status all were associated with higher prevalence of recurrent headache and the association was evident for all three headache diagnoses. Negative lifestyle factors were common in the adolescent population studied with low physical activity in 31%, smoking in 19%, and being overweight in 16%. In adjusted multivariate analyses, recurrent headache was associated with being overweight (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.2–1.6, P < 0.0001), low physical activity (OR = 1.2, 95% CI 1.1–1.4, P = 0.002), and smoking (OR = 1.5, 95% CI 1.3–1.7, P < 0.0001). The association between frequent (weekly and daily) headaches and being overweight was strongest for migraine, intermediate for TTH, and not significant for non-classifiable headache.
Commentary
Headaches are underdiagnosed and undertreated in young people, but these studies emphasize to parents and pediatricians that complaints of headaches should be investigated. Migraine is more common than tension-type headache in children and adolescents. Adult-based diagnostic criteria for migraine and chronic migraine are overrestrictive for young children, as pediatric migraine often is short-lived and the pain may be overshadowed by gastrointestinal symptoms. Even parents with migraines may minimize the import of their children's headaches, leading to delay in diagnosis and treatment. Frequency of headaches in children is influenced by frequency of headaches in the mother and seems to aggregate in families.
Being overweight, smoking, and low physical activity are associated with multiple types of recurrent headache among adolescents, both independently and in combination. The accompanying editorial by Hershey and Lipton pointed out that these lifestyle factors associated with headache in adolescents could be viewed as risk factors, exacerbating factors, or trigger factors. A causal association is not clear and the interplay between health habits and headaches is complicated. Because some medications used to prevent recurrent headaches may have problematic side effects, headache prevention by lifestyle adjustment should be attempted prior to initiation of other interventions. The overlap between headache and cerebrovascular risk factors is of concern, and may impact the association between migraine and ischemic stroke. Prevention of headaches, and stroke as well, should begin in childhood with better health habits. Michelle Obama's Let's Move! initiative has the laudable goal of ending childhood obesity within a generation and should decrease the risk of both headaches and stroke in the present generation of young people.
Migraine headaches are more common than tension-type headaches in children and adolescents. Being overweight, smoking, and being sedentary are associated with recurrent migraine and tension-type headaches in adolescents.Subscribe Now for Access
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