Psychiatric Comorbidities Common in Children With Chronic Headache

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Children and teens with chronic headache pain and suspected of having an underlying psychiatric disorder should be screened for anxiety and depression.
Children and teens with chronic headache pain and suspected of having an underlying psychiatric disorder should be screened for anxiety and depression.

Pediatric patients with chronic daily headache (CDH) may be at increased risk for comorbid psychiatric conditions, according to a review published in Seminars in Pediatric Neurology.1

Although psychiatric comorbidities are common in adults with CDH, their prevalence in the pediatric population remains unclear, wrote Hope O'Brien, MD, and Shalonda Slater, PhD, from the Cincinnati Children's Hospital Medical Center in Ohio.

Researcher from 2014 identified psychiatric comorbidity in up to 65.5% of children and adolescents with migraine,the most common type of chronic daily headache. The prevalence was significantly higher than that previously reported by Dr Slater in 2012 (29.6%).3


Pediatric patients with migraine were significantly more likely to have comorbid anxiety than those in the general population (15% to 56% vs 5.8%). The prevalence of depression disorders ranged from 4.7% to 25%, representing an increase over the general rate for children under the age of 13 (2.5%).

The findings also showed an increased risk for suicide, pain medication overuse, and truancy among adolescents aged 12 to 15 years with CDH. Attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) were also reported.

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Pediatric patients with tension-type headaches had even higher rates of psychiatric comorbidity (75%), with anxiety most commonly reported (68.8%).

According to the authors, the findings highlight the need for clinician awareness and use of appropriate screening measures at the time of CDH diagnosis.

“Evaluation of chronic headaches in children and adolescents should include a validated screening tool for comorbid conditions,” Dr O'Brien, an associate professor of neurology and director of the Young Adult Headache Clinic at Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio, told Clinical Pain Advisor.

“More studies are needed investigating the topic of comorbid psychological conditions in children and adolescents with migraine, especially during the transitional period into adulthood.  By identifying psychiatric illness and treating early, we aim to improve outcomes and quality of life in individuals suffering from chronic headaches,” Dr O'Brien emphasized.

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