Chronic Migraine, Medication Overuse Headaches Common Among Teen Headache Sufferers

BY DIANA MAHONEY
Elsevier Global Medical News

BOSTON (EGMN) - The prevalence of chronic daily headaches in adolescents increases with age and is higher in girls than boys, according to a study presented May 2 at the annual meeting of the American Academy of Neurology.

Additionally, chronic migraine and medication overuse headaches are the most common subtypes of chronic daily headaches in adolescents, and the experience of allodynia is particularly linked to chronic migraines among teens with any chronic daily headache, said Dr. Richard B. Lipton of Albert Einstein College of Medicine, New York.

To assess the prevalence and burden of chronic daily headaches and its subtypes in a large, representative population sample of adolescents, Dr. Lipton, along with lead author Dr. Brian M. Grosberg of Montefiore Medical Center and colleagues, conducted a three-stage population-based panel study. In stage 1 of the study, the investigators mailed questionnaires to a representative sample of 88,408 U.S. adolescents ranging in age from 12 to 19 years, from which episodic and chronic daily headache sufferers were identified. Chronic daily headaches were defined as the occurrence of 15 or more headaches per month lasting 4 or more hours per day.

In the study's second stage, the investigators conducted computer-assisted telephone interviews in a random sample of the two types of headache sufferers and used validated tools for diagnosis, disability assessment, and allodynia. They utilized this information to classify the chronic daily headaches into one of four subtypes according to the International Classification of Headache Disorders, 2nd edition: chronic migraine, medication overuse headache, chronic tension type headache, and other chronic daily headache. The results were then benchmarked to the U.S. Census data, Dr. Lipton said in a poster presentation. Daily telephonic headache diaries of headache experience were collected in the study's third stage, and they will be reported separately, he noted.

A total of 24,712 adolescents returned the completed questionnaire; 890 reported chronic daily headache, for an adjusted 1-month population prevalence of 2.9%, which is substantially lower than the 4%-5% prevalence reported in adults, said Dr. Lipton. The experience of chronic daily headaches was significantly more common in girls than boys, and the prevalence in both girls and boys increased with age, he said.

Of the adolescents who met the criteria for chronic daily headache, medication overuse headaches were the most common subtype, with a prevalence of 0.87%, followed by chronic migraine (0.76%) and chronic tension type headache (0.04%), said Dr. Lipton, who noted that the prevalence of allodynia - sensitivity to touch on part or all of the face that occurs with headache - varied with headache subtype, ranging from 59% among chronic migraine sufferers to 33% in adolescents with chronic tension type headaches.

Based on the pediatric Migraine Disability Assessment (pedMIDAS) scale, 61% of the chronic daily headache sufferers overall had severe disability (grade IV), according to the data.

The findings of this study are useful to the design and implementation of intervention strategies for chronic daily headaches in the adolescent population, according to Dr. Lipton.

"Although chronic daily headaches are relatively rare in adolescents, they're common enough that doctors treating these kids should be aware of them," said Dr. Lipton. Additionally, the high prevalence of medication overuse headache as a subtype in adolescents is especially relevant. "Most of the medication being overused is over the counter. Doctors need to be asking about medication use and should be considering it as a cause of headache," he said.

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