Headache in children and adolescents aged 6–18 years in Northern Italy: Prevalence and risk factors

Abstract

Objective

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.

Design and methods

A 60-item questionnaire was completed by a school-based sample (n = 1536, ages 6–18 years). Diagnostic assessment of primary headache and periodic syndromes was established in first section; predisposing conditions in the second section; while the third section quantified the frequency of self medication and identified drugs most frequently used.

Results

Headache was reported by 62.1% of subjects. Socioeconomic status, composition of family unit and nutrition habits in the first year of life did not appear significantly different in subjects with headache compared to healthy controls. A good sleep quality was found in 95.2% of healthy controls, in 89.4% of children with occasional headache. Recurrent abdominal pain, motor weakness and car sickness was significantly higher in primary headache group compared to occasional headache. Depressive/anxious traits were significantly higher in primary headache and occasional headache groups than in healthy controls. The frequency of aggressive traits was also higher in children with primary headache compared to occasional headache and healthy control subjects. 72.5% of subjects with primary headache and 58.4% of children with occasional headache assumed medicines to relieve pain. Paracetamol was the most frequently assumed drug.

Conclusions

Our data show a more frequent occurrence of anxious/depressive profile in children suffering from primary headache. In agreement with literature data, this research points out that self-treatment is a relevant problem in paediatric headache.

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.