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May 9, 2006 -- Kids who have frequent migraines and other types of severe headaches are also more likely to have emotional, behavioral, and social problems, according to findings from the first-ever national study of headaches and mental healthmental health among children.
Researchers with the CDC estimated that more than 3.7 million children in the U.S. (ages 4 to 17) have experienced frequent and severe headaches over the past year. Not surprisingly, children who have frequent headache pain are also more likely to report decreased quality of life.
A survey showed that children with frequent severe headaches were 3.5 times more likely than other children to report emotional symptoms, including being worried, unhappy, nervous, and scared.
They were 2.5 times more likely than children without frequent headaches to exhibit behavioral problems such as anger, fighting, lying, and cheating. And they were 2.6 times more likely to exhibit problems with hyperactivity and inattention.
Mental Health and Headaches
CDC epidemiologist Tara W. Strine, MPH, says headaches and other types of pain among children and adolescents are widely misunderstood, underdiagnosed, and undertreated.
She says it is unclear from the study if the frequent headaches were to blame for the emotional and behavioral problems or if these problems were a cause of the headaches.
"We know from adult studies that people with frequent headaches are more likely to exhibit emotional and mental health issues," she tells WebMD. "There is a connection, but we are not sure what the connection is."
Stine and colleagues used data from surveys of adults (parent or legal guardian) living with 9,264 children between the ages of 4 and 17 who were enrolled in an ongoing national health study.
They found that children who had migraines and other types of frequent severe headaches were roughly three times as likely as children who did not have headaches to have sought treatment for emotional or behavioral problems or to be receiving special education services for such problems.
The findings suggest that the medical management of frequent headaches in children should include an exploration of potential physical and psychological causes.
The study is published in the May 2006 issue of the American Pediatrics Association journal Pediatrics.
"If all you do is give a child headache medication, that is not necessarily going to resolve the headache issue," Stine says. "With illness we tend to separate the mind from the body, but with headaches the two are often connected. That is just as true of children as it is with adults."
Quality-of-Life Issues
Headache treatment specialist Scott Powers, PhD, says the study confirms that frequent headaches are common in children and that they have a tremendous impact on quality-of-life issues.
But he added that it was limited by the fact that researchers could not assess the impact of headache treatment on emotional and behavioral issues.
Powers is co-director of the Cincinnati Children's Headache Center, which treats about 500 children a year. He is also a spokesman for the American Academy of Pediatrics.
His own research suggests that frequent, uncontrolled headaches have a greater impact on emotional development, school performance, and other psychosocial issues than most other health problems children may face.
"The assumption has to be that the children [in the latest study] had frequent headache pain that was not well controlled. So it isn't surprising that they were having more quality-of-life problems and other issues," he tells WebMD.
Pain Relief
He says the typical new patient at the Cincinnati center is about age 11, has had migraines or other frequent headaches for three to four years, and has already seen several specialists who failed to help them.
When headache pain is adequately treated, Powers says, emotional and behavioral problems often resolve.
"In some cases kids may have headaches and depressiondepression or headaches and behavioral struggles, and these issues don't get better when the headaches are treated," he says. "But there are usually other things going on in these children's lives."
SOURCES: Strine, T.W. Pediatrics, May 2006; vol 116: pp 1728-1736. Tara W. Strine, MPH, epidemiologist, CDC, Atlanta. Scott Powers, PhD, co-director, Cincinnati Children's Headache Center.