Chronic daily headache in adolescents
An 8-year follow-up study
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Objective: To assess the long-term outcome of a community-based adolescent cohort with chronic daily headache (CDH).
Methods: A field sample of 122 adolescents aged 12–14 years with CDH was established in 2000 (baseline) with short-term follow-up studies in 2001 and 2002. In 2008, the cohort was re-interviewed by physicians via telephone to determine the headache profile for the past year, including Migraine Disability Assessment (MIDAS), a headache disability questionnaire. Presence of CDH was defined as ≥15 headache days/month, average ≥4 hours/day for >3 months. Outcome measures included headache frequency, MIDAS score, and presence of CDH in 2008.
Results: A total of 103 subjects (26 male/77 female, mean age 21.6 ± 0.9 years) completed the study (response rate 84.4%). The average monthly headache frequency was 4.7 ± 6.0 (0–30) days. Twenty-eight (27.2%) subjects had moderate or severe headache disability (MIDAS ≥11). Twelve (12%) subjects met CDH criteria, with chronic migraine (n = 10, 83%) as the most common subtype. Two (2%) subjects overused medications. From 2000 to 2008, the frequencies of migraine diagnoses were fairly consistent in this cohort. Presence of migraine at baseline predicted poorer outcome of all 3 measures. Additionally, CDH onset <13 years old, duration ≥2 years, and medication overuse predicted either higher headache frequencies or presence of CDH in 2008.
Conclusions: This long-term follow-up study revealed a marked decline in the frequency of chronic daily headache (CDH). However, one fourth of patients still had significant headache disability. Migraine history was a major factor in evolution of CDH into young adulthood. Early onset and longer duration of CDH implied a protracted disease course.
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REFERENCES
1.
Dodick DW. Chronic daily headache. N Engl J Med 2006;354:158–165.
2.
Hershey AD, Powers SW, Bentti AL, LeCates S, deGrauw TJ. Characterization of chronic daily headaches in children in a multidisciplinary headache center. Neurology 2001;56:1032–1037.
3.
Bigal ME, Lipton RB, Tepper SJ, Rapoport AM, Sheftell FD. Primary chronic daily headache and its subtypes in adolescents and adults. Neurology 2004;63:843–847.
4.
Koenig MA, Gladstein J, McCarter RJ, Hershey AD, Wasiewski W. Pediatric Committee of the American Headache Society. Chronic daily headache in children and adolescents presenting to tertiary headache clinics. Headache 2002;42:491–500.
5.
Galli F, Patron L, Russo PM, Bruni O, Strambi LF, Guidetti V. Chronic daily headache in childhood and adolescence: clinical aspects and a 4-year follow-up. Cephalalgia 2004;24:850–858.
6.
Headache Classification Subcommittee of the International Headache Society. The International classification of headache disorders, 2nd ed. Cephalalgia 2004;24 (suppl 1):1–160.
7.
Headache Classification Committee. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia 2006;26:742–746.
8.
Silberstein SD, Olesen J, Bousser MG, et al. The International Classification of Headache Disorders, 2nd edition (ICHD-II) revision of criteria for 8.2 medication-overuse headache. Cephalalgia 2005;25:460–465.
9.
Diener HC, Limmroth V. Medication-overuse headache: a worldwide problem. Lancet Neurol 2004;3:475–483.
10.
Wang SJ, Fuh JL, Lu SR, Juang KD. Chronic daily headache in adolescents: prevalence, impact, and medication overuse. Neurology 2006;66:193–197.
11.
Wang SJ, Juang KD, Fuh JL, Lu SR. Psychiatric comorbidity and suicide risk in adolescents with chronic daily headache. Neurology 2007;68:1468–1473.
12.
Wang SJ, Fuh JL, Lu SR, Juang KD. Outcomes and predictors of chronic daily headache in adolescents: a 2-year longitudinal study. Neurology 2007;68:591–596.
13.
Stewart WF, Lipton RB, Kolodner K, et al. Reliability of the migraine disability assessment score in a population-based sample of headache sufferers. Cephalalgia 1999;19:107–114.
14.
Hung PH, Fuh JL, Wang SJ. Validity, reliability and application of the Taiwan version of the Migraine Disability Assessment Questionnaire. J Formos Med Assoc 2006;105:563–568.
15.
Silberstein SD, Lipton RB, Sliwinski M. Classification of daily and near-daily headaches: field trial of revised IHS criteria. Neurology 1996;47:871–875.
16.
Lu SR, Fuh JL, Chen WT, Juang KD, Wang SJ. Chronic daily headache in Taipei, Taiwan: prevalence, follow-up and outcome predictors. Cephalalgia 2001;21:980–986.
17.
Scher AI, Stewart WF, Ricci JA, Lipton RB. Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain 2003;106:81–89.
18.
Wang SJ, Fuh JL, Lu SR, et al. Chronic daily headache in Chinese elderly: prevalence, risk factors, and biannual follow-up. Neurology 2000;54:314–319.
19.
Fuh JL, Wang SJ, Lu SR, Tsai PH, Lai TH, Lai KL. A 13-year long-term outcome study of elderly with chronic daily headache. Cephalalgia 2008;28:1017–1022.
20.
Bigal ME, Sheftell FD, Tepper SJ, Rapoport AM, Lipton RB. Migraine days decline with duration of illness in adolescents with transformed migraine. Cephalalgia 2005;25:482–487.
21.
Bigal ME, Rapoport AM, Sheftell FD, Tepper SJ, Lipton RB. Chronic migraine is an earlier stage of transformed migraine in adults. Neurology 2005;65:1556–1561.
22.
Breslau N, Lipton RB, Stewart WF, Schultz LR, Welch KM. Comorbidity of migraine and depression: investigating potential etiology and prognosis. Neurology 2003;60:1308–1312.
23.
Breslau N, Davis GC, Schultz LR, Peterson EL. Migraine and major depression: a longitudinal study. Headache 1994;34:387–393.
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Published online: July 15, 2009
Published in issue: August 11, 2009
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Wang et al. [1] reported findings from a longitudinal study following a chronic daily headache (CDH) cohort of adolescents for eight years. Their primary conclusion was that the frequency of CDH declined markedly from baseline to follow-up. However, given the disability and financial burden that CDH entails, several other findings from this study are important and deserve highlighting.
The authors found these predictors of high frequency episodic migraine (HFEM) or CDH at follow up: chronic daily headache in patients <13 years of age; duration of CDH >2 years; and medication overuse. Pathophysiologically, longstanding repetitive migraine attacks are associated with white matter lesions and iron deposition in the periaqueductal gray matter. In longitudinal studies, this correlates with long duration of migraine and probably reflects cerebral injury. [2,3] Acute central sensitization explains progression of individual migraine attacks and chronic central sensitization probably plays a role in the progression of the disease. Repeated episodes of central sensitization are associated with permanent neuronal damage, treatment refractoriness, and disease progression. [4]
The authors found that 12% of their CDH patients were no better after 8 years, which is an urgent call for early treatment of the pediatric migraineur. In an observational study, Kabbouche et al. assessed the long-term effectiveness and outcome of multidisciplinary treatment of childhood headaches from one to five years after initial treatment. [5] The treatment was effective and associated with improvement of multiple outcome measures of pediatric migraine care including frequency, severity, and missed school days.
These issues translate into a vital public health message: Parents, teachers, and pediatricians must be educated about the existence and need for aggressive treatment of children with frequent episodic migraine. The misdiagnosis (i.e., sinus headache, eye strain or dental headaches) or trivialization of pediatric migraine needs to be prevented to ensure early targeted treatment and to prevent progression to HFEM or CDH.
Early comprehensive targeted therapy under existing guidelines for childhood and adolescent migraine may prevent this progression, its associated disability, and even lead to disease modification in a subset of patients. [5]
References
1. Wang S, Fuh J, Lu S, Chronic daily headache in adolescents; an 8-year follow up study. Neurology 2009;73:416-422.
2. Welch KMA, Nagesh V, Aurora SK, Gelman N. Periaqueductal gray matter dysfunction in migraine: cause or the burden of illness? Headache 2001;106:81-89.
3. Kruit MC, van Buchem MA, Hofman PA et al. Migraine as a risk factor for subclinical brain lesions. JAMA 2004;291:427-434.
4. Burstein R et al. Defeating migraine pain with triptans: the race against the development of cutaneous allodynia. Ann Neurol 2004;55:19-26.
5. Charles JA, Peterlin BL, Rapoport AM, Linder S, Kabbouche MA, Sheftell FD. Favorable outcome of early treatment of new onset child and adolescent migraine – implications for disease modification. J Headache and Pain 2009;10:227-233.
Disclosures: Dr. Charles reports no disclosures. Dr. Peterlin has received honoraria and/or grants from GSK, Endo, Merck, OrthoMcNeil and Pfizer; has a patent for the use of adiponectin modulating agents in migraine; and is an Associate Editor for Headache. Dr. Rapoport serves on the Advisory Boards of Endo, MAP, Merck, NuPathe and Pfizer and was on the Advisory Board of Ortho; serves on the speakers' bureau of Endo, Merck and Pfizer; has served as a consultant for Boston Scientific and Roxro; and is an Editor of Headache and Neurology Reviews.
We thank Dr. Charles et al. for their interest in our article. [1] We agree that although our study showed most adolescent subjects with chronic daily headache (CDH) had a marked decline of headache frequency during the 8-year follow-up, it is remarkable that one fourth of them had moderate to severe headache disability and 12% had CDH with chronic migraine being the most common.
Dr. Charles and his colleagues stressed the importance of early intervention in pediatric migraine. However, the evidence is lacking on whether early intervention can alter the long-term prognosis of CDH. Our study showed that CDH in adolescents is quite fluid and most of our participants did not receive any specific treatment.
It is necessary for clinical trials to be conducted in this age group with CDH to prove the efficacy of early intervention. The population with the four poor outcome predictors including migraine diagnosis; CDH onset <_13 years="years" old="old" cdh="cdh" duration="duration"/>=2 years; and medication overuse should be targeted for early intervention.
Disclosure: Dr. Wang has served on the advisory boards of Pfizer, Allergan, and MSD Taiwan; has received speaker honoraria from Taiwan branches of Pfizer, Eli Lilly, Wyeth, Jensen-Cilag, Boehringer Ingelheim, and GSK; and has received research support from the Taiwan National Science Council, Taipei-Veterans General Hospital, and MSD Taiwan. Dr. Fuh serves on the scientific advisory board of Pfizer and has received research support from the Taiwan National Science Council and Taipei-Veterans General Hospital. Dr. Lu has received research support from the Taiwan National Science Council and Kaohsiung Medical University, Taiwan.