Children and Teens with Chronic Headaches Need Psychiatric Evaluation
We typically think of headaches as an adult disease. If a child or teen does complain of an occasional headache, we often assess them for head trauma. In kids and teens headaches can also be the result of a bad cold or fever. If a child or teen complains of chronic headaches, a new study suggests that they should be evaluated for psychiatric comorbidities.
The recent review in the journal Seminars in Pediatric Neurology, acknowledges that CDH (chronic daily headaches) are common in adults and psychiatric comorbidities may be contributing to the headaches, but there is little research that has evaluated the prevalence and etiology of CDH in the pediatric and teen population. A study from 2014 suggested the need for psychological therapies to help manage chronic recurrent pain in kids and teens. Among the chronic pain conditions listed in the study that were well managed with psychological therapies were chronic, painful headaches.
When it comes to children and teens who suffer with chronic daily headaches:
• Research suggests that there is a psychiatric comorbidity in 65.5% of kid and teen chronic daily headaches that are identified as migraines
• Data suggests that 7% of kids and teens suffer with CDH
• Pediatric patients with chronic daily migraines were more likely to have “comorbid anxiety” compared to the general pediatric population
• Comorbid depression was also higher in kids and teens with chronic migraines, compared to the general population
• Overall, teens with chronic migraines have higher rates of suicide, pain medication overuse, and truancy compared to teens who did not suffer with migraines.
• ADHD and oppositional defiant disorder (ODD) rates were also higher in the teens suffering with chronic migraines.
• Pediatric-age patients with tension-type headaches had higher rates of psychiatric comorbidities, with anxiety the most commonly reported associated comorbidity.
Researchers suggest that when clinicians are evaluating chronic daily or frequent headaches in kids and teens, there should be a standardized screening tool for comorbid conditions (like stress, anxiety and depression). The screening is especially important when kids are transitioning into the teen age years. Identifying and treating psychiatric illness early allows for improved treatment, outcomes and quality of life for these patients. Trained health professionals should be responsible for the screening, which should be a comprehensive, in depth history and examination, so that more serious psychiatric comorbidities are not missed or misdiagnosed as anxiety or stress.
Screening options should include the SDQ or Strength and Difficulties Questionnaire that is available in many languages and is credited for its ability to identify psychosocial problems in teens that suffer with recurrent headaches. The DWBA or Development and Well-Being Assessment is another effective screening and diagnostic tool used worldwide.
HealthCorps curriculum includes lessons that support mental strength, helping teens to cope with and manage daily stress and anxiety.