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.

Rate of Psychiatric Disorders

As many as 7% of children and adolescents may suffer from CDH, defined as primary headaches that occur at least 15 days per month for at least 3 months. 

Although there appears to be a significant degree of comorbid mood and behavioral conditions in pediatric CHD, the true prevalence and underlying psychopathology remain unclear, the authors wrote.

“The rate of psychiatric diagnosis reported for these patients is variable, ranging from 29.6% to as high as 65.5%,” Dr Slater, an assistant clinical professor and pediatric psychologist in the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children's Hospital Medical Center, told Clinical Pain Advisor.

“Unfortunately, it has also been reported that only 36.2% of adolescents in general receive needed mental health services, indicating that mental health services among adolescents are underutilized,” Dr Slater pointed out.

According to clinical psychologist Meghan McMurtry, PhD, the increased prevalence of both psychiatric symptoms and diagnoses in populations with CDH makes sense because pain has both sensory and emotional components.

“Whether or not a physical or organic ‘cause' for pain is found, an individual's pain experience and expression are influenced by biological (eg, genetics), psychological (eg, symptoms of anxiety), and social factors (eg, responses of others), and these factors are also influenced themselves by pain,” Dr McMurtry told Clinical Pain Advisor.

“It's important though to make a distinction between symptoms of anxiety, depression, and behavioral issues and the presence of psychiatric disorders. The diagnosis of a mental disorder requires a trained health professional and not just a questionnaire,” Dr McMurtry added.

Dr McMurtry, who was not involved in the study, is an assistant professor of clinical psychology from the University of Guelph in Ontario, Canada, and a clinical psychologist with the pediatric chronic pain program at McMaster Children's Hospital in Hamilton, Ontario.

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