Original articleHeadache in children and adolescents aged 6–18 years in Northern Italy: Prevalence and risk factors
Introduction
Headache is the most common manifestation of pain in childhood and is often accompanied by significant disability, such as school absenteeism, low-quality performance and an impaired emotional functioning leading to negative relationship with peers and family.1
Although headache is increasingly being perceived as a significant health problem by paediatricians and parents, its frequency has not been well defined. Epidemiological studies suggest that headache is rare before the age of four years but its frequency increases throughout childhood, reaching a peak at about 13 years of age. Among school children, as many as 65%–75% has experienced headache at least once in the lifetime; about 10% suffer from primary headache.2 The most frequent types of primary headache are migraine and tension-type headache that occur respectively in 2–17% and in 0.9–24%.3, 4, 5
Periodic syndromes such as abdominal pain, cyclical vomit and paroxysmal vertigo are considered as migraine equivalents in pre-school age children.6, 7, 8 Recurrent abdominal pain (RAP) without organic cause, motor weakness and car sickness are also common paediatric conditions and several studies have stressed their co-occurrence with headache.9, 10, 11, 12
Regarding aetiology, headache is a genetic-dependent and hereditary disorder: first degree relatives of subjects with migraine have 1.9 times the risk of developing migraine compared with the general population.13, 14 However, the development of primary headache may be furthered by many other environmental conditions that are not well defined yet.
Furthermore, paediatric headache often embraces a series of psychopathological personality traits found in anxiety-linked and depressive disorders.15
When a primary headache is under-diagnosed, the risk is an immoderate use of over the counter analgesics.16 Since drug overuse makes treatment of headache difficult to deal,17 it is important to supervise this condition, which is particularly common in adolescents.
Therefore, early accurate diagnosis and comprehensive effective treatment are essential to minimize the impact on a child’s quality of life and may result in the prevention of long term disability.
The aim of this study is to examine the epidemiology of paediatric headache and periodic syndromes in a school population and to evaluate the co-existence of environmental predisposing conditions such as socioeconomic status, composition of family unit, nutrition habits in the first year of life and sleep quality. We investigated the co-occurrence of somatic complaints such as RAP, motor weakness and car sickness, and the presence of constant emotional and behavioural profiles in cephalalgic children. Frequency of self medication use for treatment of pain has also been evaluated.
Section snippets
Procedure
A questionnaire made up of 60 items, was administered to 2000 school children aged 6–18 years in five public schools of Milan. Following a prenotice letter, informing the household of the upcoming survey, questionnaires were distributed by the present authors. The study was conducted during a period between January 2007 and December 2008. All items were compiled by the participant individually in the presence of a parent who ensured that the subject carried out the tests properly.
Questionnaire development
Prior the
Results
Of the 2000 questionnaires distributed, 1536 (76.8%) were accepted for statistical analysis. The remaining 464 tests were excluded because 164 were incomplete in the first section and 300 subjects refused to answer. The 1536 subjects constituting our study population were divided as follows: 585 boys and 950 girls aged 6–18 years.
Discussion
In paediatric literature it is extensively recognized that headache is a frequent cause of significant disability, affecting the child life, school performance and their relationship with family and peers.22 Early accurate diagnosis and comprehensive effective treatment are essential to minimize the impact on a child’s quality of life and may result in the prevention of long term disability. Considering that headache is an extremely common symptom in children and adolescents, we recruited the
Conclusions
Our study confirms literature data on epidemiology of headache. The most consistent results were found about age, gender, periodic syndromes, positive family history, sleep quality and somatic complaints.
Indices of behavioural and emotional difficulties were elevated among children suffering from headache; future prospective research is needed to determine whether specific behaviours precede the onset of headache, emerge concurrently with headache symptoms, or follow the manifestation of
Conflicts of interest
No potential conflicts of interest.
Funding
Support: No commercial or financial support.
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