Headache Quiz: Tension; Chronicity; Children and Adolescents

Question 1. Tension Headache

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Answer

B.False

According to a recent Cochrane Review of five studies¹ evaluating aspirin vs placebo, a single dose of 500 mg or 1000 mg aspirin provided some relief over placebo in the treatment of frequent episodic tension-type headache. Fifty-five percent of participants reported being satisfied with aspirin, vs 27% with placebo, and 14% of participants needed rescue medication with aspirin 1000 mg vs 31% with placebo. Adverse events were similar for aspirin and placebo.

See: 1. Derry S, Wiffen PJ, Moore RA. Aspirin for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev. 2017 Jan 13;1:CD011888. doi: 10.1002/14651858.CD011888.pub2.

Question 2. Chronicity

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Answer

D. All of the above

Studies suggest that exposure to extreme violence may increase the risk for chronic headache later on. Soldiers who have experienced military combat may suffer from a range of chronic pain conditions, including chronic headache and/or migraine.¹ Child abuse, both physical and sexual, has been associated with migraine.² A recent Norwegian study found that adolescent survivors of a mass shooting had over four times increased odds of frequent migraine and over three times increased odds of frequent tension type headache.³ Central sensitization and dysregulation of the HPA axis, autonomic, immune and metabolic systems may be involved.

See: 1. George E, Elman I, Becerra L, Berg S, Borsook D. Pain in an era of armed conflicts: prevention and treatment for warfighters and civilian casualties. Prog Neurobiol. 2016;141:25–44.

2. Tietjen GE. Childhood maltreatment and headache disorders. Curr Pain Headache Rep. 2016;20:26.

3. Stensland SØ, Zwart JA, Wentzel-Larsen T, et al. The headache of terror: A matched cohort study of adolescents from the Utøya and the HUNT Study.Neurology. 2018;90:e111-e118.

Question 3: Children and adolescents

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Answer

C. 9%

According to a recent review of 64 epidemiological studies, about 9% of children and adolescents worldwide have suffered from migraine, and about 54% have suffered from headache.¹ However, chronic migraine may be rarer in children and adolescents. According to one study, fewer than 1% (0.79%) of US adolescents suffer from chronic migraine, but those who do are heavily burdened by it. The majority of adolescents with chronic migraine had test scores indicating severe headache and headache-related disability.²

See: 1. Wöber-Bingöl C. Epidemiology of migraine and headache in children and adolescents. Curr Pain Headache Rep. 2013;17:341.

2. Lipton RB, Manack A, Ricci JA, et al. Prevalence and burden of chronic migraine in adolescents: results of the chronic daily headache in adolescents study (C-dAS).Headache. 2011;51:693-706.