Schooling Changes During COVID-19 Pandemic Suggestive of Improved Headache Coping Ability for Pediatric Patients


Headache frequency remained the top driver of higher disability scores, but opposing to prior findings, school versus summer was not a significant predictor of disability, suggesting that pandemic schooling changes affected coping abilities to cause less disability.

Brian LaGrant, MD, pediatric neurology resident, CHOP

Brian LaGrant, MD

New data from a retrospective analysis of children and adolescents who attended outpatient visits for new headache at the Children’s Hospital of Philadelphia (CHOP) suggest that the changes in schooling during the COVID-19 pandemic may have affected how these patients cope with headaches.1

In total, the assessment included 8528 unique individuals aged 5 to 21 years (mean age, 12.9; SD, 3.5) and showed that of all the variables assessed—the presence of COVID-19, age, presence of school, the interaction between school and COVID-19, and headache frequency—headache frequency had the most pronounced effect on Pediatric Migraine Disability Assessment (PedMIDAS) scores. Compared with those who experienced headaches on a less-than-weekly basis, those who had continuous headaches (odds ratio [OR], 6.2), 3 headaches or more per week (OR, 3.4), or 1 to 2 headaches per week (OR, 2.4) all had an increased chance of reporting higher scores (for all, P <.001).

This study examined how the COVID-19 pandemic affected headache disability, as measured by the PedMIDAS, in children who presented to a large academic child neurology clinic for a new patient visit,” investigator Brian LaGrant, MD, pediatric neurology resident, CHOP, and colleagues, who presented the data at the 2022 American Headache Society (AHS) Annual Scientific Meeting, June 9-11, in Denver, Colorado, wrote. “Contrary to prior studies, school versus summer was not a significant predictor of disability. This may reflect that changes in school related to the COVID-19 pandemic affected children and adolescents’ ability to cope with headaches in a way that caused less disability.”

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Additionally, adolescents, defined as those ages 13 to 21 years, showed increased odds of higher disability scores than children, those aged 5 to 12 years (OR, 1.9; P <.001). The presence of COVID-19 was negatively associated with higher disability scores, despite statistical adjustments for headache frequency (OR, 0.72; P <.001). Notably, the timing of patients being in school vs on summer break, and the interaction between school and COVID-19, did not affect the odds of higher disability in the fully adjusted model.1

“This study confirms prior work showing that headache frequency is the primary driver of disability, and that adolescents have higher levels of disability compared to children. However, even after adjusting for headache frequency, children and adolescents presenting to outpatient neurology for a new visit during the COVID-19 pandemic had lower headache disability scores,” LaGrant et al concluded.

The group noted that primary headache disorders are common in children and are often associated with significant morbidity. Existing literature has shown seasonal variation in headache disability. A 2014 study by Caparell et al in Pediatric Emergency Care showed that among more than 2700 pediatric emergency department visits for headache, a nadir was present in May and June, while visits significant peaked in September, October, and November (P <.001).2 Similar results were reported in Headache in 2006, by Soriani et al, with a population of 2517 migraine attacks in 115 children revealing a seasonal peak between November and January, and a nadir observed in July, “suggest[ing] that school activities may represent an important cause of migraine.”3

“The COVID-19 pandemic caused major changes, including virtual schooling and decreased peer interaction. There is limited research describing how headache disability changed during the COVID-19 pandemic, but some work suggests improvement in headache disability during this time,” LaGrant and colleagues wrote.

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1. Lagrant B, Hershey AD, Szperka C. Headache disability in children and adolescents before and during the COVID-19 pandemic. Presented at: AHS Annual Scientific Meeting; June 9-11, 2022; Denver, CO. Front-02.
2. Caperell K, Pitetti R. Seasonal Variation of Presentation for Headache in a Pediatric Emergency Department. Ped Emergency Care. 2014;30(3):174-176. doi:10.1097/PEC.0000000000000027
3. Soriani S, Fiumana E, Manfredini R, et al. Circadian and seasonal variation of migraine attacks in children. Headache. 2006;46:1571-1574.
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