Headaches, migraine prevalent in older teens

Pediatric News, August, 2007 by Diana Mahoney

BOSTON -- Approximately one in four adolescents aged 16-18 years in the United States is affected by severe headache or migraine, Dr. Tarannum Lateef reported in a poster presentation at the annual meeting of the American Academy of Neurology.

Dr. Lateef of Children's National Medical Center in Washington and colleagues also found that childhood headache is associated with multiple factors, including race/ethnicity, indices of poverty, and comorbid conditions.

They assessed the prevalence of severe headache or migraine and possible comorbid conditions in U.S. children aged 4-18 years using data from the National Health and Nutrition Examination Survey from 1999 to 2004.

Of 10,918 children surveyed, 17% reported having severe headache or migraine in the prior 3 months, and headache prevalence was highest, at 19%, in African Americans and lowest, at 15%, in Mexican Americans, according to the results.

Additionally, the prevalence increased with age, up to 27% in 16- to 18-year-olds, said Dr. Lateef, and it was higher among girls than among boys, at rates of 32% and 23%, respectively.

Analyses of socioeconomic variables found that reported headache frequency rose with decreasing status. Headache and migraine prevalence was increased in children receiving free or reduced-price school lunches and in children whose families were classifted as poor based on the poverty index ratio, according to Dr. Lateef. Additionally, "children with headache had decreased school attendance and increased utilization of health care resources."

Regarding comorbidities, headache and migraine prevalence were associated with anemia, attention-deficit disorder, learning disorders, and overweight status, she said. Also, asthma, hay fever, and frequent ear infections were more common in children with headache, with at least one of these occurring in 42% of children with headache, vs. 25% of children free of headache.

The investigators observed a trend toward an increased prevalence of headache and migraine in children younger than 6 years old. In successive 2-year periods, the prevalence rose from 3.6% to 4.1% and then to 5.8%.

However, "this trend, which appeared to emerge after our initial analysis, was not found to be statistically significant on further investigation," she said.

"Our findings indicate that migraine or frequent, severe headaches are a common childhood complaint and, therefore, will be frequently encountered by pediatricians and neurologists," reported Dr. Lateef.

"Our data also suggest that [these] children often have significantly higher medical comorbidities, compared with children without headache," she added.

Because comorbidity can influence the delivery of medical care, as it can confound diagnoses and provide special therapeutic challenges, "knowledge of other biologic systems involved would not only help physicians provide better care for patients but may also provide some clues as to the shared pathophysiology of headache and these other conditions," Dr. Lateef said.

BY DIANA MAHONEY

New England Bureau