Chronic daily headache in adolescents. Prevalence, impact, and medication overuse. Neurology

Tzu Chi University, Hua-lien, Taiwan, Taiwan
Neurology (Impact Factor: 8.29). 01/2006; 66(2):193-7. DOI: 10.1212/01.wnl.0000183555.54305.fd
Source: PubMed


To examine the prevalence, impact, and related medication use or overuse of primary chronic daily headache (CDH) among adolescents in a field sample.
The authors conducted a two-phase CDH survey of all students from ages 12 to 14 years in five selected middle schools in Taiwan. Subjects with CDH in the past year were identified and interviewed by neurologists. CDH was defined as headache occurring at a frequency of 15 days/month or more, average of 2 hours/day or more, for more than 3 months, and its subtypes were classified on the basis of the International Classification of Headache Disorders, 2nd edition.
Of the 7,900 participants, 122 (1.5%) fulfilled the criteria for primary CDH in the past year. Girls had a higher prevalence (2.4%) than boys (0.8%) (p < 0.001). Of the CDH subjects, 88 (72%) could be classified into either chronic tension-type headache (65.6%) or chronic migraine (6.6%). None of them fulfilled the criteria of new daily-persistent headache or hemicrania continua. Twenty-four subjects (20%) overused medications. Eighty-two (67%) of all CDH subjects had migraine or probable migraine. In the past semester, most CDH subjects (65%) did not take any sick leave for headaches. Only 6 subjects consulted neurologists in the past year, and only 1 subject took headache prophylactic agents.
Chronic daily headache (CDH) was common in a large nonreferred adolescent sample. Based on the International Classification of Headache Disorders, 2nd edition, criteria, chronic tension-type headache was the most common subtype; however, a majority of adolescents with CDH had headaches with features of migraine.

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Available from: Jong-Ling Fuh, May 30, 2014
    • "Management of CDHs is a challenge because they cause significant morbidity if not treated effectively and in a timely manner (Galli et al., 2004; Spittler, 2008). CDHs have an adverse impact on the adolescent's daily functioning (Hershey, Gladstein, & Winner, 2007), emotional/mental health (Wang, Fuh, Lu, & Juang, 2006), work and academic performance (Tenhunen & Elander, 2005; Wang et al., 2006), and overall functional performance (Gilman, Palermo, Kabbouche, Hershey, & Powers, 2007). Current clinical management is based largely on interventions focusing on adults, findings from childhood episodic studies, and expert opinion (Mack, 2010), with many interventions focusing on pharmacologic treatment modalities studied in adults (Schottenfeld, 2012). "
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    ABSTRACT: Introduction The treatment challenge of adolescents with chronic daily headaches (CDHs) creates an urgent need for evidence-based interventions. Therefore the purpose of this pilot study was to evaluate the acceptability, feasibility, and preliminary effects of a brief cognitive behavioral skills building intervention with 36 adolescents, 13 to 17 years of age, who had CDHs and mild to moderate depressive symptoms. Methods Participants were randomly assigned either to the Creating Opportunities for Personal Empowerment–Headache Education Program (COPE-HEP) or to a headache education comparison group. Results Adolescents and parents found the COPE-HEP to be highly acceptable. Medium to large positive effects were demonstrated on the adolescents' depression in both groups and on anxiety and beliefs in the COPE-HEP group. COPE-HEP offered additional benefits of a larger decrease in adolescent anxiety over time and stronger beliefs in the teens' ability to manage their headaches. Discussion Adolescents with CDHs and elevated depressive/anxiety symptoms should be offered headache hygiene education plus cognitive-behavioral skills building interventions. A full-scale trial to determine the more long-term benefits of COPE-HEP is now warranted.
    Journal of Pediatric Health Care 07/2014; 29(1). DOI:10.1016/j.pedhc.2014.05.001 · 1.44 Impact Factor
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    • "The prevalence seems to decrease with increasing age, and among people over 65 years, the prevalence based on different definitions has been reported to be 1.0%–1.5%.47,48 The prevalence of MOH in children and adolescents has been suggested to be 0.3%–0.5%.49,50 In studies of specialist care in children, approximately 20% of patients with chronic headache had medication-overuse, suggesting MOH to be a problem also in school-aged children.51,52 "
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    ABSTRACT: Medication-overuse headache (MOH) is a worldwide health problem with a prevalence of 1%-2%. It is a severe form of headache where the patients often have a long history of headache and of unsuccessful treatments. MOH is characterized by chronic headache and overuse of different headache medications. Through the years, withdrawal of the overused medication has been recognized as the treatment of choice. However, currently, there is no clear consensus regarding the optimal strategy for management of MOH. Treatment approaches are based on expert opinion rather than scientific evidence. This review focuses on aspects of epidemiology, diagnosis, pathogenesis, prevention, and treatment of MOH. We suggest that information and education about the risk of MOH is important since the condition is preventable. Most patients experience reduction of headache days and intensity after successful treatment. The first step in the treatment of MOH should be carried out in primary care and focus primarily on withdrawal, leaving prophylactic medication to those who do not manage primary detoxification. For most patients, a general practitioner can perform the follow-up after detoxification. More complicated cases should be referred to neurologists and headache clinics. Patients suffering with MOH have much to gain by an earlier treatment-focused approach, since the condition is both preventable and treatable.
    Journal of Pain Research 06/2014; 7:367-78. DOI:10.2147/JPR.S46071
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    • "The prevalence decreases with older age and, among people over 65 years in Taiwan, the prevalence was 1.0% [Wang et al. 2000]. The prevalence of MOH in children and adolescents has been suggested to be 0.3–0.5% [Dyb et al. 2006; Wang et al. 2006]. MOH generally starts earlier in life than other types of chronic headache [Colás et al. 2004]. "
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    ABSTRACT: Medication-overuse headache (MOH) is one of the most common chronic headache disorders and a public health problem with a worldwide prevalence of 1-2%. It is a condition characterized by chronic headache and overuse of different headache medications, and withdrawal of the overused medication is recognised as the treatment of choice. However, the strategy for achieving withdrawal is, at present, based on expert opinion rather than scientific evidence, partly due to the lack of randomised controlled studies. This narrative review investigates different aspects of epidemiology, diagnosis, risk factors and pathogenesis as well as management for MOH. We suggest that the first step in the treatment of MOH should be carried out in general practice and should focus primarily on detoxification. For most patients, both prevention and follow up after detoxification can also be performed in general practice, thus freeing resources for referral of more complicated cases to headache clinics and neurologists. These suffering patients have much to gain by an earlier treatment-focused approach lower down on the treatment ladder.
    Therapeutic Advances in Drug Safety 03/2014; 2(5):87-99. DOI:10.1177/2042098614522683
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