Sunday, September 23, 2018

Long-term follow-up of a community sample of adolescents with frequent headaches

Larsson B, Sigurdson JF, Sund AM. Long-term follow-up of a community sample of adolescents with frequent headaches. J Headache Pain. 2018 Sep 4;19(1):79.


Several outcome studies have reported on the short- and long-term effects of migraine in selected clinical samples of children and adolescents. However, current knowledge of the course, incidence, and outcome predictors of frequent headaches in early adolescents in community populations is limited, and little is known about the long-term effects. Headache remains untreated in most of these young people. Here we examined the course, incidence, and outcome predictors of frequent headaches (at least once a week) over the long term (14 years) using previously assessed data at the baseline and 1-year follow-up of early adolescents.

Out of an original sample of 2440 who participated in the first two assessments, a sample of 1266 participants (51.9% response rate) aged 26–28 years (mean = 27.2 years) completed an electronic questionnaire comprising questions about their headache frequency and duration at the long-term follow-up. These headache characteristics together with gender, age, parental divorce, number of friends, school absence, impairment of leisure-time activities and seeing friends, pain comorbidity, and emotional (in particular, depressive symptoms) and behavioral problems were analyzed.

In these young people, 8.4% reported frequent headaches (at least once a week) at the extended follow-up, while 19% of the participants having such headaches at baseline again reported such levels with a negligible gender difference. Over the follow-up period, 7.4% had developed frequent headaches, and a higher percentage of females reported such headaches (11.3% in females, 1.5% in males). In a multivariate model, frequent headaches at the baseline, gender (worse prognosis in females), impairment of leisure-time activities and seeing friends, and higher level of depressive symptoms significantly predicted headache frequency at the long-term follow-up.

Our findings suggest that gender, greater social impairment, and comorbid depressive symptoms are important indicators for both the short- and long-term prognosis of frequent headaches in early adolescents in community populations.

From the manuscript

We found that a sizable proportion of adults aged 26–28 years reported frequent headaches to the same extent as they did in early adolescence. This and other findings of short- and long-term follow-up studies of community samples of children and adolescents suggest that there is strong risk for continuation of frequent headaches commonly associated with higher levels of emotional problems and impairment in social activities. In the long-term perspective, they are likely to have developed into chronic tension-type or migraine headaches or a combination. Although the prevalence of headaches improves in a substantial proportion of adolescents as they move into adulthood, the persistence of frequent headaches, particularly among girls, along with higher levels of depressive symptoms and impairment, emphasizes the need to provide effective psychological and pharmacological treatments to reduce frequent headache complaints and their associated social burden.

In future longitudinal research, more frequent and repeated assessment over time will reveal whether changes in persistence, improvement rates, and relapses occur in adolescents with recurrent headaches. This information will improve the identification of individuals experiencing persistent frequent headaches over extended periods. More importantly, for these people, the potential influence of gender, presence of depressive symptoms, and extent of impairment should be tested in the context of controlled treatment trials to examine whether these factors also contribute to changing the outcome.

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