Psychiatric Comorbidities Common in Children With Chronic Headache

Screening Options in General Practice

Some of the variation in comorbidity prevalence rates may be due to inconsistencies in study sample populations; symptom severity may be higher among pediatric patients getting care in a specialty clinic than in general practice.

“The point of the review was to reiterate the importance of making the correct headache diagnosis in pediatric and adolescent patients using the ICHD-III criteria and assessing the potential for mood and anxiety disorders using validated screening measures,” Dr Slater said.

Screening options include the Strength and Difficulties Questionnaire (SDQ), a low-cost, brief measure that has been validated in many languages and recognized for its ability to detect psychosocial problems in adolescents with recurrent headaches. The Development and Well-Being Assessment (DWBA) is also used worldwide and has been referenced in epidemiologic studies.

In contrast, the Pediatric Symptom Checklist, Child Depression Inventory, and Child Behavior Checklist are not sensitive for psychiatric disorders, and may yield false results by not accounting for the emotional effects related to coping with chronic illness, the authors wrote, noting that these are best used to identify patients in need of further evaluation.

“An important message for clinicians is that the experience of pediatric chronic daily headache is complex and that these individuals should be screened for symptoms of anxiety, depression, and externalizing behavioral difficulties in order to guide best treatment practices,” Dr McMurtry said.

A Comprehensive Approach to Treatment

Once a mood disorder has been identified, treatment should include psychological interventions such as cognitive behavior therapy (CBT), which has been shown to improve function and pain in pediatric CDH when used alone or in combination with antidepressants, the authors wrote.

Dr McMurtry concurred, explaining that patients with chronic pain, including CDH, may become quite fearful of their pain and withdraw from certain activities.

Over time, this can have unintended negative consequences because it tends to lead to lower mood, higher anxiety, withdrawal from important activities, and increased pain and disability,” Dr McMurtry said.

“Cognitive behavior therapy can help individuals challenge their thoughts, problem-solve the situation, and improve their coping skills to reduce their pain and/or increase their ability to go to school, socialize, and engage in hobbies,” Dr McMurtry added.

The recommended approach to treating pediatric chronic pain involves psychological, pharmacological, and physical factors, and family support is critical for helping a child cope and implement changes, Dr McMurtry concluded.


1. O’Brien H, Slater S. Co-morbid psychological conditions in pediatric headaches. Semin Pediatr Neurol. Published Online: January 21, 2016. doi:10.1016/j.spen.2016.01.002.

2. Machnes-Maayan D, Elazar M, Apter A, Zeharia A, Krispin O, Eidlitz-Markus T. Screening for psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain.  Pediatr Neurol. 2014;50(1):49-56.

3. Slater, SK, Kashikar-Zuck SM, Allen JR, et al. Psychiatric comorbidity in pediatric chronic daily headache. Cephalalgia. 2012;32(15):1116-1122. doi:10.1177/0333102412460776.

Editor’s Note: A reference was missing from the original version of this article.  This article was revised on March 4, 2016 to reflect this correction.