Behavior issues are a bigger headache for children with migraine

Behavioral and emotional symptoms and primary headaches in children – A population-based study

From Cephalagia

Kids who get migraine headaches are much more likely than other children to also have behavioral difficulties, including social and attention issues, and anxiety and depression. The more frequent the headaches, the greater the effect. For this study the authors studied 1,856 Brazilian children aged 5 to 11. They say that this is the first large, community based study of its kind to look at how children’s behavioural and emotional symptoms correlate with migraine and tension-type headaches (TTH), and to incorporate data on headache frequency. The study used internationally validated headache questionnaires as well as the Child Behavior Checklist (CBCL) to assess emotional symptoms. Until now, few studies have examined the contrasts between TTH in children and observed headache frequency. “As previously reported by others, we found that migraine was associated with social problems, the ‘social’ domain identifies difficulties in social engagement as well as infantilized behavior for the age and this may be associated with important impact on the personal and social life.”  commented Arruda, one of the authors “Providers should be aware of this possibility in children with migraines, in order to properly address the problem.”


Objective: To investigate behavioral and emotional symptoms in a community-based sample of children as a function of headache status and of headache frequency.

Methods: Our sample consisted of 1,856 children (5–11 years). Primary headaches were assessed using a validated headache questionnaire. Emotional symptoms were assessed by the Child Behavior Checklist (CBCL). CBCL scores were modeled as a function of headache status after adjustments for demographics and headache frequency.

Results: Relative to controls, children with migraine were significantly more likely to have abnormalities in the following CBCL domains: somatic, anxiety-depressive, social, attention, internalizing and total score. Children with tension-type headache (TTH) were significantly different from controls in the same domains but at a lower rate than migraine. In children with migraine, impairments significantly varied as a function of headache frequency, race, and income. In children with TTH, gender, age, and headache frequency were significantly associated with abnormal scores.

Conclusions: Migraine and TTH are significantly associated with behavioral symptoms in several domains, and headache frequency affects the association. Internalizing symptoms are common in children with headaches, while externalizing symptoms (e.g. rule-breaking and aggressivity) are not significantly more common than in controls.

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Article details
Marco A Arruda and, & Marcelo E Biga (2012). Behavioral and emotional symptoms and primary headaches in children: A population-based study Cephalalgia : 10.1177/0333102412454226

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