DÄ internationalArchive48/2013Headache in School Children

Review article

Headache in School Children

Prevalence and Risk Factors

Dtsch Arztebl Int 2013; 110(48): 811-8. DOI: 10.3238/arztebl.2013.0811

Straube, A; Heinen, F; Ebinger, F; Kries, R v

Background: Recurrent headache is a common problem in school children. Evaluation generally leads to the diagnosis of a primary headache syndrome (migraine or tension-type headache). This review is addressed to the question whether headaches in school children are becoming more common and, if so, what risk factors are associated with the rise in frequency.

Methods: We selectively searched the PubMed database for pertinent publications that contained the terms “primary headache AND children/adolescent AND risk factors/prevalence.” Articles published in either English or German up to April 2013 were considered. Articles on secondary types of headache were excluded.

Results: Headaches are becoming more common among school children. At present, 66% to 71% of 12- to 15-year-olds have at least one headache every three months, and 33% to 40% have at least one per week. Headache is often accompanied by other physical and/or emotional manifestations. Studies from Scandinavia reveal increasing prevalence in age groups from 8 years of age and upward. Various studies have identified the following risk factors for headache or for its chronification (up to 5.8-fold elevation of risk): a dysfunctional family situation, the regular consumption of alcohol, caffeine ingestion, smoking, a low level of physical activity, physical or emotional abuse, bullying by peers, unfair treatment in school, and insufficient leisure time.

Conclusion: Headaches are becoming more common among children and adolescents. They are often associated with other physical and emotional complaints.

LNSLNS

Headaches are one of the most common complaints in the general population, as well as among children and adolescents. In school children the most common form are primary headaches, defined as headaches not associated with an underlying disorder (group 1–4, IHS classification (1). The median frequency of headaches (1-month to lifetime prevalence) in 50 population-based studies was 58.4% in school children, while the prevalence of migraine headaches was 7.7% (2). The ratio of girls to boys was 1.5:1 (all headaches) and 1.7:1 (migraines). Secondary headaches (headaches associated with an underlying disease) are uncommon in patients with recurrent headaches. The prevalence of headaches in school children (11–18 years of age) in Turkey was 34.1% for primary headaches and 4.4% for secondary (e1). The most common causes of secondary headaches were viral respiratory infections (29–39%) and mild skull injuries (3) (Boxes 1, 2).

IHS criteria for migraine without aura
Box 1
IHS criteria for migraine without aura
IRS criteria for infrequent episodic tension-type headache
Box 2
IRS criteria for infrequent episodic tension-type headache

Methods

This review was prepared as an expert consensus (modified Delphi technique). Publications that were identified through a selective literature search in PubMed (through April 2013) under the key word combinations „primary headache AND children AND prevalence“ (318 citations); „primary headache AND adolescent AND prevalence“ (411 citations); „primary headache AND children AND risk factors“ (84 citations); and „primary headache AND adolescent AND risk factors“ (115 citations) were reviewed by at least one author. Only publications in English or German which had appeared in a peer-reviewed journal were considered.

Clinical features of primary headaches in children and adolescents

The median age for the onset of headaches was 7.5 years (4). The clinical signs and symptoms differed from those in adults. In children it is often impossible to distinguish with certainty between migraines and tension-type headache (e2). The duration of migraine attacks is shorter (it can be less than two hours) (e2, e3) and is rarely longer than 12 to 24 hours. The headaches are more often bilateral and associated nausea and vomiting decrease with increasing age (e4). Intense pain and a pulsatile nature suggest migraines. These usually start in the morning hours (58.5%) and resolve after a period of sleep (76.7%). The most specific features separating migraines from tension-type headache are improvement after sleeping, the presence of nausea and vomiting, worsening with physical activity and photo-, phono- or osmophobia (5).

Children can have a variety of migraine equivalents including:

  • cyclic vomiting (recurrent stereotypic attacks with nausea, vomiting and need for rest)
  • abdominal migraines (episodes of abdominal pain, loss of appetite, nausea and introverted behavior)
  • benign paroxysmal vertigo of childhood (recurrent attacks of vertigo, sometimes with nystagmus).

The diagnosis of abdominal migraines was made in 4.4% of 600 children referred to a pediatric gastroenterology clinic for recurrent abdominal pain (6). Small children with such symptoms are at an increased risk of developing migraines or tension-type headache later (7, e5). In adolescents (12–15 years of age), the clinical symptomatology of migraines and tension-type headache is similar to that of adults. The stability of the diagnosis over time is less for headaches in childhood, as compared to those in adults. Only 30–50% of those patients diagnosed with migraines received the same diagnosis when evaluated three years later (e6). A migraine with aura, usually visual, was present in 23–50% of cases (e3, e4). In childhood and adolescence, spontaneous remissions are uncommon; in a Swedish study, 80% of patients still had headaches three years later (8). A parental survey revealed that over a year 57% of children showed no changes in their headaches, while 22% improved and 21% worsened (9). Patients in whom initiation of therapy is delayed have less chance of becoming free of headaches (e7). Girls are less likely to clear than boys (e7). A high frequency of headaches and the diagnosis of migraines predict headaches later in life (10). tension-type headache resolves more often than migraines.

Effects of headaches on quality of life and health

Children and adolescents with headaches frequently describe a number of other somatic complaints and emotional disturbances. Among children who were evaluated in a special pain clinic, 74.5% had headaches while 55% had other pain diagnoses, such as abdominal pain or back pain (11). The combined appearance of various somatic complaints (headaches, back pain, gastrointestinal complaints, sleep disorders, allergic diseases) can already be observed in 5- to 7-year-olds (12, 13) (Table 1).

Association of somatic complaints with headache/migraine, age group 13–18
Table 1
Association of somatic complaints with headache/migraine, age group 13–18

Among 2200 children who were re-questioned one year after their initial evaluation, over half reported two or more types of pain (14). Girls were more likely to have multiple forms and only 27% were free of pain. A similar association of headaches with other complaints was also seen in a survey of high school students:

  • headaches (83%)
  • back pain (48%)
  • increased tiredness (47%)
  • neck or shoulder pain (45%) (15).

Neck and shoulder pain were mentioned significantly more often by students with migraines than by those with tension-type headache (16). Behavioral disorders were also more common in children with migraines (e8). We identify an increased risk for affective disorders and attention deficit/hyperactivity disorder in adolescents with migraine headaches (e9). There is conflicting data over the association of depression or anxiety disorders with headaches, but the majority of publications indicate that adolescents with headaches are at greater risk for these problems as well as for psychopathological disturbances (e10e12). For example, the suicide risk is elevated in adolescents with chronic headaches (e13).

Effect of age on the prevalence of chronic headaches

Parents tend to underestimate the headaches of their children (e14) and the distinction between migraines and tension-type headache is difficult in this age group (e15). Epidemiologic cross-sectional (4, 17, 18) and longitudinal (19) studies show that the prevalence of headaches increases with age; in 7-year-olds it is 37–51% increasing to 57–82% in 15-year-olds (20, 21), In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), headaches were the most common pain in the group 11–17 years of age, surpassing abdominal pain and back pain (the 3-month prevalence for all forms of pain was 77.6%) (22). The prevalence of migraines was 3.8% for 5- to 12-year-olds (23) and 6.9% for 12- to 15-year-olds (24). In a German study the prevalence of headache was 39% for 7-year-olds and 63% for 14-year- olds (4). Similar results were found in the USA (17) and Sweden (18). This tendency to increase with age was confirmed by a longitudinal study over six years which identified an increase in prevalence from 45.2% to 78.7% (19).

In addition, there is an increasing prevalence of frequent headaches (at least once weekly) with increasing age (24, e16e18). Gaßmann et al. (25) reported that 3.6% of 8-year-olds and 10.7% of 15-year-olds had at least one headache weekly. Other studies contain similar prevalence estimates for weekly headaches:

  • in Canada (26.3% of the 12- to 13-year-olds and 31.2% of the 14- to 15-year-olds [e16])
  • in southern England (20%) (17) and
  • in Italy (40% of the 11- to 15-year-olds (e18).

In the region of Greifswald, Germany, 9.6% of the 12-year-olds and 12.1% of the 15-year- olds reported headaches for at least 14 days over the preceding 3 months (24). Chronic migraines (migraine headaches >15 days/month for at least 3 months) were found in 0.1% of school children (24).

Frequent headaches also lead to an increased use of pain medications. In Brazil, 6.7% of children report taking an analgesic for more than 5 days monthly (23). In the Head-HUNT-youth study, the prevalence of daily headaches associated with overuse of medications (analgesics on >15 days/month; opiates or triptans >10 days/month) was 0.8% among girls and 0.2% among boys (e19).

A variety of studies show an increasing prevalence of headaches in children. In Finland 1000 8-year-old school children were queried in both 1989 and 1999. The prevalence of frequent headaches increased by a factor of 1.5 (e20). Another Finnish study evaluated more than 1000 7-year-olds in Turku in 1974, 1992 and 2002; the prevalence of migraines rose from 14.5/1000 in 1974 to 91.9/1000 in 2002. The same trends were seen for migraines with and without aura, as well as for headaches in general (26, 27). In Denmark both tension-type headache and frequent migraines increased over a 12-year period in young adults (28). The percentage of migraine patients with more than 14 attacks annually rose over 12 years from 24% to 38% (28). In Uppsala, Sweden, 1800 school children ranging from 7 to 15 years of age were surveyed to compare the frequency of tension-type headache with that in 1955. There was a significant increase in the prevalence of migraines from 3.9% to 6.6% and the share of children without headaches dropped from 41.4% (1955) to 16% (1997) (18). We found no increase in the prevalence of headaches in German adults between 1995 and 2010, in sharp contrast to all the evidence demonstrating an increase in children (29). In Norway there was a slight increase in the prevalence of migraines in adults (12.1% to 13.2%) but not for headaches in general (e21). Longitudinal studies on the frequency of migraines in adults in the USA and France (from 1989 to 1999) also showed no increase (e22, e23).

The data strongly suggest that headaches (especially migraines) are now appearing earlier in life even though the overall prevalence has not increased. The number of patients with frequent headaches is increasing in parallel fashion.

Risk factors for headaches in school children

Various studies have identified risk factors but interventional or preventive studies showing that altering such factors influences headache prevalence are lacking.

In general, one can divide the risk factors into the categories of life style, school and psyche. Typical frequently confirmed life style factors include:

  • caffeine ingestion
  • alcohol ingestion
  • smoking
  • lack of physical activity.

Regular caffeine intake correlates with the frequency of headaches in adults (30) and adolescents (31). Both the HUNT study and a survey of high-school students in Munich, Germany, showed a significant association between smoking and headaches (31, 32). In contrast to adults (33, e24), in adolescents ingestion of alcohol is also a risk factor. A significant association between drinking cocktails and headaches was found among high school students (31). Both the HUNT and Munich studies showed a correlation with lack of physical activity (31, 32). Not surprisingly, being overweight is also associated with childhood headaches (32, 34). An American study showed that losing weight was also correlated with a reduction in headaches (34). Other studies showed no influence by the daily fluid intake (31), skipping meals (31) or a history of meningitis (e25). Daily computer use (video games, electronic media) also had no effect (e26).

Stress at school as well as high parental expectations are risk factors for increased headaches. Two studies show that regular free time (true free time without planned activites) reduces the risk of getting headaches (25). In a survey of high school students, 80% complained of headaches and over 40% had less than two unplanned hours per day (15).

Additional risk factors include emotional stress arising from both family and daily life factors. In a study from the German state of Lower Saxony, a correlation between regular family conflicts and headaches was seen, especially in boys (25). A Taiwanese study showed that children with chronic headaches, when compared to the total population, had a significantly lower Global Family Environment Score and more frequently reported physical abuse and separation of their parents (e27).

Several studies (35, e28e31) have shown a correlation between physical abuse and the frequency of headaches. In addition to physical abuse, both sexual and emotional abuse, as well as lack of attention, were significant risk factors for both early onset and chronicity of headaches (e30). This relationship was independent of the diagnosis of depression or anxiety disorder (e30, e31). In contrast, a cooperative, non-punitive family relationship protected against headaches (36, e16) (Table 2).

Risk factors for headaches in children and adolescents
Table 2
Risk factors for headaches in children and adolescents

School is a major part of every child’s world. Research has devoted considerable attention to the influence of bullying and physical trauma on development of somatic and emotional problems. For example, the risk of developing recurrent headache increases by 25% when school children feel their teacher is treating them unfairly (e18). Conversely, feeling fairly treated reduces the risk by more than 40% (e16). Bullying increases the risk of developing headaches (37) and of taking pain medications (38). There is a close correlation between the perceived severity of the bullying and the frequency of the headaches. A cross-sectional study in 28 countries showed that occasional bullying increases the risk by 40%, while weekly bullying raises it by 80–90% (38).

If one groups all these factors together as stressors, then one can ask if the perceived stress correlates with headache frequency. Studies that show a correlation between frequency of migraines and examination periods point in this direction (e33). About 20% of high school students complain of excessive stress, usually but not always naming school as the main stress factor (15). The subjective level of stress was higher in students with migraines than in those with tension-type headache or without headaches (e34) (Table 2).

Conclusion and therapeutic consequences

Headaches in children and adolescents are increasing in frequency. They appear to be embedded in the complex of somatic and emotional maturation processes and complaints. Since the prevalence of headaches in not increasing in the general adult population in Germany, we suspect there is a dual acceleration process:

  • transition from childhood to puberty and adolescence occurs earlier and
  • headaches appear earlier and more often in adolescence.

External factors must be responsible, as the genetic matrix cannot have changed so rapidly. Increasing time demands (with resultant loss of true free time), pressure to succeed from school and family, and increased social pressures from both peer group and school all seem important. Individual, context-dependent risk factors include reduced physical activity, smoking, increased consumption of caffeine and alcohol, and being overweight.

When counseling patients, these risk factors should be addressed. Evaluation of headache treatment programs has shown that effective patient counseling is a major part of any therapeutic success (e35e37). Early results are also available for Internet-based programs that offer cognitive behavioral therapy or relaxation techniques. Both approaches are equally effective (e38). Regular athletic activity (e39) and insuring free, unplanned time are also both helpful. As in other areas of pediatric drug therapy, the treatment of childhood headaches has not been well-addressed in controlled studies. Reviews are available (39, 40) (Table 3, 4).

Pharmacologic and non-pharmacologic therapy of migraines
Table 3
Pharmacologic and non-pharmacologic therapy of migraines
Pharmacologic and non-pharmacologic therapy of tension-type headache
Table 4
Pharmacologic and non-pharmacologic therapy of tension-type headache

If there is evidence suggesting that familial or school issues are causing emotional stress, child and adolescent psychologists or psychiatrists should be integrated into the therapeutic plan. Children and adolescents who complain of chronic headaches or multiple types of pain benefit from an interdisciplinary therapeutic approach. In this group, psychiatric co-morbidities such as depression, anxiety disorders or somatization are common (36) and the risk of a chronic course is high. Frequent pain in childhood is a risk factor for chronic pain as an adult (e40). Thus it is crucial to develop preventive strategies to address headaches in school children at the earliest possible point.

Conflict of interest statement
Prof. Straube received lecture honoraria or travel costs from: Allergan, Hormosan, Boehringer Ingelheim, Merck Serono, Desitin, Pfizer, Berlin Chemie and MSD. He received research support or honoraria for carrying out scientific studies from: Allergan, Novartis, MSD, Boehringer Ingelheim, Weber & Weber, FGK, Fresenius Stiftung, DFG and BMBF.

Prof. Heinen received honoraria for serving as an advisor to Allergan.

PD Dr. med. Ebinger received funds for clinical contract studies from AstraZeneca.

Prof. von Kries declares that no conflict of interest exists.

Manuscript received on 10 September 2012, revised version accepted on 13 August 2013.

Translated from the original German by Walter Burgdorf, MD.

Corresponding author:
Prof. Dr. med. Andreas Straube
Neurologie, Campus Großhadern
Universität München
81377 München, Germany
astraube@nefo.med.uni-muenchen.de

@For eReferences please refer to:
www.aerzteblatt-international.de/ref4813

1.
Headache Classification Committee of the International Headache Society (IHS):The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33: 629–808. CrossRef MEDLINE
2.
Abu-Arafeh I, Razak S, Sivaraman B, Graham C: Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol 2010; 52: 1088–97. CrossRef MEDLINE
3.
Celle ME, Carelli V, Fornarino S: Secondary headache in children. Neurol Sci 2010; 31: 81–2. CrossRef MEDLINE
4.
Kröner-Herwig B, Heinrich M, Morris L: Headache in German children and adolescents: a population-based epidemiological study. Cephalalgia 2007; 27: 519–27. CrossRef MEDLINE
5.
Knezevic-Pogancev M: Specific features of migraine syndrome in children. J Headache Pain 2006; 7: 206–10. CrossRef MEDLINE PubMed Central
6.
Carson L, Lewis D, Tsou M, McGuire E, Surran B, Miller C, Vu TA: Abdominal migraine: an under-diagnosed cause of recurrent abdominal pain in children. Headache 2011; 51: 707–12. CrossRef MEDLINE
7.
Arruda MA, Guidetti V, Galli F, Albuquerque RC, Bigal ME: Childhood periodic syndromes: a population-based study. Pediatr Neurol 2010; 43: 420–4. CrossRef MEDLINE
8.
Laurell K, Larsson B, Mattsson P, Eeg-Olofsson O: A 3-year follow-up of headache diagnoses and symptoms in Swedish schoolchildren. Cephalalgia 2006; 26: 809–15. CrossRef MEDLINE
9.
Gaßmann J, Morris L, Heinrich M, Kröner-Herwig B: One-year course of paediatric headache in children and adolescents aged 8–15 years. Cephalalgia 2008; 28: 1154–62. CrossRef MEDLINE
10.
van Dijk A, McGrath PA, Pickett W, VanDenKerkhof EG: Pain prevalence in nine- to 13-year-old schoolchildren. Pain Res Manag 2006; 11: 234–40. MEDLINE PubMed Central
11.
Zernikow B, Wager J, Hechler T, Hasan C, Rohr U, Dobe M, Meyer A, Hübner-Möhler B, Wamsler C, Blankenburg M: Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients. BMC Pediatr 2012; 12: 54. CrossRef MEDLINE PubMed Central
12.
Rask CU, Olsen EM, Elberling H, Christensen MF, Ornbøl E, Fink P, Thomsen PH, Skovgaard AM: Functional somatic symptoms and associated impairment in 5–7-year-old children: the Copenhagen Child Cohort 2000. Eur J Epidemiol 2009; 24: 625–34. CrossRef MEDLINE
13.
Lateef TM, Cui L, Nelson KB, Nakamura EF, Merikangas KR: Physical comorbidity of migraine and other headaches in US adolescents. J Pediatr 2012; 161: 308–13. CrossRef MEDLINE
14.
Kröner-Herwig B, Gaßmann J, van Gessel H, Vath N: Multiple pains in children and adolescents: a risk factor analysis in a longitudinal study. J Pediatr Psychol 2011; 36: 420–32. CrossRef MEDLINE
15.
Milde-Busch A, Blaschek A, Borggräfe I, von Kries R, Straube A, Heinen F: Is there an association between the reduced school years in grammar schools and headache and other health complaints in adolescent students? Klin Padiatr 2010; 222: 255–60. CrossRef MEDLINE
16.
Blaschek A, Milde-Busch A, Straube A, Schankin C, Langhagen T, Jahn K, Schröder SA, Reiter K, von Kries R, Heinen F: Self-reported muscle pain in adolescents with migraine and tension-type headache. Cephalalgia 2012; 32: 241–9. CrossRef MEDLINE
17.
Lateef TM, Merikangas KR, He J, Kalaydjian A, Khoromi S, Knight E, Nelson KB: Headache in a national sample of American children: prevalence and comorbidity. J Child Neurol 2009; 24: 536–43. CrossRef MEDLINE PubMed Central
18.
Laurell K, Larsson B, Eeg-Olofsson O: Prevalence of headache in Swedish schoolchildren, with a focus on tension-type headache. Cephalalgia 2004; 24: 380–8. CrossRef MEDLINE
19.
Ozge A, Sasmaz T, Cakmak SE, Kaleagasi H, Siva A: Epidemiological-based childhood headache natural history study: after an interval of six years. Cephalalgia 2010; 30: 703–12. CrossRef MEDLINE
20.
Dooley JM, Gordon KE: Headaches in childhood. Can J Neurol Sci 2004; 31: 291–2. MEDLINE
21.
Zwart JA, Dyb G, Holmen TL, Stovner LJ, Sand T: The prevalence of migraine and tension-type headaches among adolescents in Norway. The Nord-Trøndelag Health Study (Head-HUNT-Youth), a large population-based epidemiological study. Cephalalgia 2004; 24: 373–9. CrossRef MEDLINE
22.
Du Y, Knopf H, Zhuang W, Ellert U: Pain perceived in a national community sample of German children and adolescents. Eur J Pain 2011; 15: 649–57. CrossRef MEDLINE
23.
Arruda MA, Guidetti V, Galli F, Albuquerque RC, Bigal ME: Primary headaches in childhood-a population-based study. Cephalalgia 2010; 30: 1056–64. CrossRef MEDLINE
24.
Fendrich K, Vennemann M, Pfaffenrath V, Evers S, May A, Berger K, Hoffmann W: Headache prevalence among adolescents-the German DMKG headache study. Cephalalgia 2007; 27: 347–54. CrossRef MEDLINE
25.
Gaßmann J, Vath N, van Gessel H, Kröner-Herwig B: Risk factors for headache in children. Dtsch Arztebl Int 2009; 106(31–32): 509–16. VOLLTEXT
26.
Anttila P, Metsähonkala L, Sillanpää M: Long-term trends in the incidence of headache in Finnish schoolchildren. Pediatrics 2006; 117: e1197–201. CrossRef MEDLINE
27.
Sillanpää M, Anttila P: Increasing prevalence of headache in 7-year-old schoolchildren. Headache 1996; 36: 466–70. CrossRef MEDLINE
28.
Lyngberg AC, Rasmussen BK, Jørgensen T, Jensen R: Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey. Eur J Epidemiol 2005; 20: 243–9. CrossRef MEDLINE
29.
Straube A, Aicher B, Förderreuther S, Eggert T, Köppl J, Möller S, Schneider R, Haag G: Period prevalence of self-reported headache in the general population in Germany from 1995–2005 and 2009: Results from annual nationwide population-based cross-sectional surveys. J Headache and Pain 2013; 14: 11. CrossRef MEDLINE PubMed Central
30.
Hagen K, Thoresen K, Stovner LJ, Zwart JA: High dietary caffeine consumption is associated with a modest increase in headache prevalence: results from the Head-HUNT Study. J Headache Pain 2009; 10: 153–9. CrossRef MEDLINE PubMed Central
31.
Milde-Busch A, Blaschek A, Borggräfe I, Heinen F, Straube A, von Kries R: Associations of diet and lifestyle with headache in high-school students: results from a cross-sectional study. Headache 2010; 50: 1104–14. CrossRef MEDLINE
32.
Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart JA: An unfavorable lifestyle and recurrent headaches among adolescents: the HUNT study. Neurology 2010; 75: 712–7. CrossRef MEDLINE
33.
Aamodt AH, Stovner LJ, Hagen K, Bråthen G, Zwart J: Headache prevalence related to smoking and alcohol use. The Head-HUNT Study. Eur J Neurol 2006; 13: 1233–8. CrossRef MEDLINE
34.
Hershey AD, Powers SW, Nelson TD, Kabbouche MA, Winner P, Yonker M, Linder SL, Bicknese A, Sowel MK, McClintock W: American Headache Society Pediatric Adolescent Section. Obesity in the pediatric headache population: a multicenter study. Headache 2009; 49: 170–7. CrossRef MEDLINE
35.
Tietjen GE, Brandes JL, Peterlin BL, Eloff A, Dafer RM, Stein MR, Drexler E, Martin VT, Hutchinson S, Aurora SK, Recober A, Herial NA, Utley C, White L, Khuder SA: Childhood maltreatment and migraine (part I). Prevalence and adult revictimization: a multicenter headache clinic survey. Headache 2010; 50: 20–31. CrossRef MEDLINE
36.
Pitrou I, Shojaei T, Chan-Chee C, Wazana A, Boyd A, Kovess-Masféty V: The associations between headaches and psychopathology: a survey in school children. Headache 2010; 50: 1537–48. CrossRef MEDLINE
37.
Williams K, Chambers M, Logan S, Robinson D: Association of common health symptoms with bullying in primary school children. BMJ 1996; 313: 17–9. CrossRef MEDLINE
38.
Due P, Holstein BE, Lynch J, Diderichsen F, Gabhain SN, Scheidt P, Currie C: Health Behaviour in School-Aged Children Bullying Working Group. Bullying and symptoms among school-aged children: international comparative cross sectional study in 28 countries. Eur J Public Health 2005; 15: 128–32. CrossRef MEDLINE
39.
Bonfert M, Straube A, Schroeder AS, Reilich P, Ebinger F, Heinen F: Primary headache in children and adolescents: update on pharmacotherapy of migraine and tension-type headache. Neuropediatrics 2013; 44: 3–19. CrossRef MEDLINE
40.
Evers S, Kropp P, Pothmann R, Heinen F, Ebinger F: Therapie idiopathischer Kopfschmerzen im Kindes- und Jugendalter. Nervenheilkunde 2008; 27: 1127–37.
e1.
Alp R, Alp SI, Palanci Y, Sur H, Boru UT, Ozge A, Yapici Z: Use of the International Classification of Headache Disorders, Second Edition, criteria in the diagnosis of primary headache in schoolchildren: epidemiology study from eastern Turkey. Cephalalgia 2010; 30: 868–77. MEDLINE
e2.
Karli N, Akgöz S, Zarifoðlu M, Akiþ N, Erer S: Clinical characteristics of tension-type headache and migraine in adolescents: a student-based study. Headache 2006; 46: 399–412. CrossRef MEDLINE
e3.
Ando N, Fujimoto S, Ishikawa T, Teramoto J, Kobayashi S, Hattori A, Togari H: Prevalence and features of migraine in Japanese junior high school students aged 12–15 yr. Brain Dev 2007; 29: 482–5. CrossRef MEDLINE
e4.
Gherpelli JL, Nagae Poetscher LM, Souza AM, Bosse EM, Rabello GD, Diament A, Scaff M: Migraine in childhood and adolescence. A critical study of the diagnostic criteria and of the influence of age on clinical findings. Cephalalgia 1998; 18: 333–41. CrossRef MEDLINE
e5.
Krams B, Echenne B, Leydet J, Rivier F, Roubertie A: Benign paroxysmal vertigo of childhood: long-term outcome. Cephalalgia 2011; 31: 439–43. CrossRef MEDLINE
e6.
Mazzotta G, Carboni F, Guidetti V, Sarchielli P, Feleppa M, Gallai V, Mastropaolo C, Puca F: Outcome of juvenile headache in outpatients attending 23 Italian headache clinics. Italian Collaborative Study Group on Juvenile Headache (Società Italiana Neuropsichiatria Infantile [SINPI]). Headache 1999; 39: 737–46. CrossRef MEDLINE
e7.
Kienbacher C, Wöber C, Zesch HE, et al.: Clinical features, classification and prognosis of migraine and tension-type headache in children and adolescents: a long-term follow-up study. Cephalalgia 2006; 26: 820–30. CrossRef MEDLINE
e8.
Arruda MA, Bigal ME: Behavioral and emotional symptoms and primary headaches in children: a population-based study. Cephalalgia 2012; 32: 1093–100. CrossRef MEDLINE
e9.
Milde-Busch A, Boneberger A, Heinrich S, et al.: Higher prevalence of psychopathological symptoms in adolescents with headache. A population-based cross-sectional study. Headache 2010; 50: 738–48. CrossRef MEDLINE
e10.
Balottin U, Poli PF, Termine C, Molteni S, Galli F: Psychopathological symptoms in child and adolescent migraine and tension-type headache: a meta-analysis. Cephalalgia 2013; 33: 112–22. CrossRef MEDLINE
e11.
Pogliani L, Spiri D, Penagini F, Nello FD, Duca P, Zuccotti GV: Headache in children and adolescents aged 6–18 years in northern Italy: prevalence and risk factors. Eur J Paediatr Neurol 2011; 15: 234–40. CrossRef MEDLINE
e12.
Bruijn J, Locher H, Passchier J, Dijkstra N, Arts WF: Psychopathology in children and adolescents with migraine in clinical studies: a systematic review. Pediatrics 2010; 126: 323–32. CrossRef MEDLINE
e13.
Wang SJ, Juang KD, Fuh JL, Lu SR: Psychiatric comorbidity and suicide risk in adolescents with chronic daily headache. Neurology 2007; 68: 1468–73. CrossRef MEDLINE
e14.
Lundqvist C, Clench-Aas J, Hofoss D, Bartonova A: Self-reported headache in schoolchildren: parents underestimate their children’s headaches. Acta Paediatr 2006; 95: 940–6. CrossRef MEDLINE
e15.
Wager J, Hirschfeld G, Zernikow B: Tension-Type headache or migraine? Adolescents’ pain descriptions are of little help. Headache 2013; 53: 322–32. CrossRef MEDLINE
e16.
Dooley JM, Gordon KE, Wood EP: Self-reported headache frequency in Canadian adolescents: validation and follow-up. Headache 2005; 45: 127–31. CrossRef MEDLINE
e17.
Kernick D, Reinhold D, Campbell JL: Impact of headache on young people in a school population. Br J Gen Pract 2009; 59: 678–81. CrossRef MEDLINE PubMed Central
e18.
Santinello M, Vieno A, De Vogli R: Primary headache in Italian early adolescents: the role of perceived teacher unfairness. Headache 2009; 49: 366–74. CrossRef MEDLINE
e19.
Dyb G, Holmen TL, Zwart JA: Analgesic overuse among adolescents with headache: the Head-HUNT-Youth Study. Neurology 2006; 66: 198–201. CrossRef MEDLINE
e20.
Santalahti P, Aromaa M, Sourander A, Helenius H, Piha J: Have there been changes in children’s psychosomatic symptoms? A 10-year comparison from Finland. Pediatrics 2005; 115: e434–42. CrossRef MEDLINE
e21.
Linde M, Stovner LJ, Zwart JA, Hagen K: Time trends in the prevalence of headache disorders. The Nord-Trondelag Health Studies (HUNT 2 and HUNT 3). Cephalalgia 2011; 31: 585–96. CrossRef MEDLINE
e22.
Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M: Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 2001; 41: 646–57. CrossRef MEDLINE
e23.
Henry P, Auray JP, Gaudin AF, et al.: Prevalence and clinical characteristics of migraine in France. Neurology 2002; 59: 232–7. CrossRef MEDLINE
e24.
Winter AC, Hoffmann W, Meisinger C, et al.: Association between lifestyle factors and headache. J Headache Pain 2011; 12: 147–55. CrossRef MEDLINE PubMed Central
e25.
Linde M, Langnes HA, Hagen K, Bergh K, Stovner LJ: No increase in headache after previous intracranial infections: a historical cohort study (HUNT). Eur J Neurol 2012; 19: 324–31. CrossRef MEDLINE
e26.
Milde-Busch A, von Kries R, Thomas S, Heinrich S, Straube A, Radon K: The association between use of electronic media and prevalence of headache in adolescents: results from a population-based cross-sectional study. BMC Neurol 2010; 10: 12. CrossRef MEDLINE PubMed Central
e27.
Juang KD, Wang SJ, Fuh JL, Lu SR, Chen YS: Association between adolescent chronic daily headache and childhood adversity: a community-based study. Cephalalgia 2004; 24: 54–9. CrossRef MEDLINE
e28.
Fuh JL, Wang SJ, Juang KD, Lu SR, Liao YC, Chen SP: Relationship between childhood physical maltreatment and migraine in adolescents. Headache 2010; 50: 761–8. CrossRef MEDLINE
e29.
Tietjen GE, Brandes JL, Peterlin BL, et al.: Childhood maltreatment and migraine (part II). Emotional abuse as a risk factor for headache chronification. Headache 2010; 50: 32–41. CrossRef MEDLINE
e30.
Tietjen GE, Brandes JL, Peterlin BL, et al.: Childhood maltreatment and migraine (part III). Association with comorbid pain conditions. Headache 2010; 50: 42–51. CrossRef MEDLINE
e31.
Tietjen GE, Peterlin BL: Childhood abuse and migraine: epidemiology, sex differences, and potential mechanisms. Headache 2011; 51: 869–79. CrossRef MEDLINE
e32.
Due P, Hansen EH, Merlo J, Andersen A, Holstein BE: Is victimization from bullying associated with medicine use among adolescents? A nationally representative cross-sectional survey in Denmark. Pediatrics 2007; 120: 110–7. CrossRef MEDLINE
e33.
Bener A, Uduman SA, Qassimi EM, et al.: Genetic and environmental factors associated with migraine in schoolchildren. Headache 2000; 40: 152–7. CrossRef MEDLINE
e34.
Milde-Busch A, Blaschek A, Heinen F, et al.: Associations between stress and migraine and tension-type headache: results from a school-based study in adolescents from grammar schools in Germany. Cephalalgia 2011; 31: 774–85. CrossRef MEDLINE
e35.
Diener HC, Gaul C, Jensen R, Gobel H, Heinze A, Silberstein S: Integrated headache care. Cephalalgia 2011; 31: 1039–47. CrossRef MEDLINE
e36.
Gaul C, van Doorn C, Webering N, et al.: Clinical outcome of a headache specific multidisciplinary treatment program and adherence to treatment recommendations in a tertiary headache center. An observational study. TJHP 2011; 12: 475–83. MEDLINE
e37.
Göbel H, Heinze A, Heinze-Kuhn K, Henkel K, Roth A, Rüschmann HH: Entwicklung und Umsetzung der integrierten Versorgung in der Schmerztherapie. Das bundesweite Kopfschmerzbehandlungsnetz. Der Schmerz 2009; 23: 653–70. CrossRef MEDLINE
e38.
Trautmann E, Kröner-Herwig B: A randomized controlled trial of Internet-based self-help training for recurrent headache in childhood and adolescence. Behav Res Ther 2010; 48: 28–37. CrossRef MEDLINE
e39.
Gaul C, Totzeck A, Kraus U, Straube A: Kopfschmerz und Sport. Akt Neurol 2012; 39: 254–60. CrossRef
e40.
Knook LM, Lijmer JG, Konijnenberg AY, Taminiau B, van Engeland H: The course of chronic pain with and without psychiatric disorders: a 6-year follow-up study from childhood to adolescence and young adulthood. J Clin Psychiatry 2012; 73: e134–9. CrossRef MEDLINE
Department of Neurology, University of Munich, Campus Grosshadern: Prof. Dr. med Straube
Department of Pediatric Neurology, University of Munich, Campus Innenstadt, Dr. von Haunersches Kinderspital: Prof. Dr. med Heinen
Clinic for Child and Adolescent Medicine, St. Vincent Hospital, Paderborn, and Center for Child and Adolescent Medicine, University of Heidelberg: PD Dr. med Ebinger
Institute of Social Paediatrics and Adolescent Medicine, University of Munich: Prof. Dr. med. von Kries
IHS criteria for migraine without aura
Box 1
IHS criteria for migraine without aura
IRS criteria for infrequent episodic tension-type headache
Box 2
IRS criteria for infrequent episodic tension-type headache
Key messages
Association of somatic complaints with headache/migraine, age group 13–18
Table 1
Association of somatic complaints with headache/migraine, age group 13–18
Risk factors for headaches in children and adolescents
Table 2
Risk factors for headaches in children and adolescents
Pharmacologic and non-pharmacologic therapy of migraines
Table 3
Pharmacologic and non-pharmacologic therapy of migraines
Pharmacologic and non-pharmacologic therapy of tension-type headache
Table 4
Pharmacologic and non-pharmacologic therapy of tension-type headache
1.Headache Classification Committee of the International Headache Society (IHS):The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33: 629–808. CrossRef MEDLINE
2.Abu-Arafeh I, Razak S, Sivaraman B, Graham C: Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol 2010; 52: 1088–97. CrossRef MEDLINE
3.Celle ME, Carelli V, Fornarino S: Secondary headache in children. Neurol Sci 2010; 31: 81–2. CrossRef MEDLINE
4.Kröner-Herwig B, Heinrich M, Morris L: Headache in German children and adolescents: a population-based epidemiological study. Cephalalgia 2007; 27: 519–27. CrossRef MEDLINE
5.Knezevic-Pogancev M: Specific features of migraine syndrome in children. J Headache Pain 2006; 7: 206–10. CrossRef MEDLINE PubMed Central
6.Carson L, Lewis D, Tsou M, McGuire E, Surran B, Miller C, Vu TA: Abdominal migraine: an under-diagnosed cause of recurrent abdominal pain in children. Headache 2011; 51: 707–12. CrossRef MEDLINE
7.Arruda MA, Guidetti V, Galli F, Albuquerque RC, Bigal ME: Childhood periodic syndromes: a population-based study. Pediatr Neurol 2010; 43: 420–4. CrossRef MEDLINE
8.Laurell K, Larsson B, Mattsson P, Eeg-Olofsson O: A 3-year follow-up of headache diagnoses and symptoms in Swedish schoolchildren. Cephalalgia 2006; 26: 809–15. CrossRef MEDLINE
9.Gaßmann J, Morris L, Heinrich M, Kröner-Herwig B: One-year course of paediatric headache in children and adolescents aged 8–15 years. Cephalalgia 2008; 28: 1154–62. CrossRef MEDLINE
10.van Dijk A, McGrath PA, Pickett W, VanDenKerkhof EG: Pain prevalence in nine- to 13-year-old schoolchildren. Pain Res Manag 2006; 11: 234–40. MEDLINE PubMed Central
11.Zernikow B, Wager J, Hechler T, Hasan C, Rohr U, Dobe M, Meyer A, Hübner-Möhler B, Wamsler C, Blankenburg M: Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients. BMC Pediatr 2012; 12: 54. CrossRef MEDLINE PubMed Central
12.Rask CU, Olsen EM, Elberling H, Christensen MF, Ornbøl E, Fink P, Thomsen PH, Skovgaard AM: Functional somatic symptoms and associated impairment in 5–7-year-old children: the Copenhagen Child Cohort 2000. Eur J Epidemiol 2009; 24: 625–34. CrossRef MEDLINE
13.Lateef TM, Cui L, Nelson KB, Nakamura EF, Merikangas KR: Physical comorbidity of migraine and other headaches in US adolescents. J Pediatr 2012; 161: 308–13. CrossRef MEDLINE
14.Kröner-Herwig B, Gaßmann J, van Gessel H, Vath N: Multiple pains in children and adolescents: a risk factor analysis in a longitudinal study. J Pediatr Psychol 2011; 36: 420–32. CrossRef MEDLINE
15.Milde-Busch A, Blaschek A, Borggräfe I, von Kries R, Straube A, Heinen F: Is there an association between the reduced school years in grammar schools and headache and other health complaints in adolescent students? Klin Padiatr 2010; 222: 255–60. CrossRef MEDLINE
16.Blaschek A, Milde-Busch A, Straube A, Schankin C, Langhagen T, Jahn K, Schröder SA, Reiter K, von Kries R, Heinen F: Self-reported muscle pain in adolescents with migraine and tension-type headache. Cephalalgia 2012; 32: 241–9. CrossRef MEDLINE
17.Lateef TM, Merikangas KR, He J, Kalaydjian A, Khoromi S, Knight E, Nelson KB: Headache in a national sample of American children: prevalence and comorbidity. J Child Neurol 2009; 24: 536–43. CrossRef MEDLINE PubMed Central
18. Laurell K, Larsson B, Eeg-Olofsson O: Prevalence of headache in Swedish schoolchildren, with a focus on tension-type headache. Cephalalgia 2004; 24: 380–8. CrossRef MEDLINE
19.Ozge A, Sasmaz T, Cakmak SE, Kaleagasi H, Siva A: Epidemiological-based childhood headache natural history study: after an interval of six years. Cephalalgia 2010; 30: 703–12. CrossRef MEDLINE
20.Dooley JM, Gordon KE: Headaches in childhood. Can J Neurol Sci 2004; 31: 291–2. MEDLINE
21.Zwart JA, Dyb G, Holmen TL, Stovner LJ, Sand T: The prevalence of migraine and tension-type headaches among adolescents in Norway. The Nord-Trøndelag Health Study (Head-HUNT-Youth), a large population-based epidemiological study. Cephalalgia 2004; 24: 373–9. CrossRef MEDLINE
22.Du Y, Knopf H, Zhuang W, Ellert U: Pain perceived in a national community sample of German children and adolescents. Eur J Pain 2011; 15: 649–57. CrossRef MEDLINE
23.Arruda MA, Guidetti V, Galli F, Albuquerque RC, Bigal ME: Primary headaches in childhood-a population-based study. Cephalalgia 2010; 30: 1056–64. CrossRef MEDLINE
24.Fendrich K, Vennemann M, Pfaffenrath V, Evers S, May A, Berger K, Hoffmann W: Headache prevalence among adolescents-the German DMKG headache study. Cephalalgia 2007; 27: 347–54. CrossRef MEDLINE
25. Gaßmann J, Vath N, van Gessel H, Kröner-Herwig B: Risk factors for headache in children. Dtsch Arztebl Int 2009; 106(31–32): 509–16. VOLLTEXT
26.Anttila P, Metsähonkala L, Sillanpää M: Long-term trends in the incidence of headache in Finnish schoolchildren. Pediatrics 2006; 117: e1197–201. CrossRef MEDLINE
27.Sillanpää M, Anttila P: Increasing prevalence of headache in 7-year-old schoolchildren. Headache 1996; 36: 466–70. CrossRef MEDLINE
28.Lyngberg AC, Rasmussen BK, Jørgensen T, Jensen R: Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey. Eur J Epidemiol 2005; 20: 243–9. CrossRef MEDLINE
29.Straube A, Aicher B, Förderreuther S, Eggert T, Köppl J, Möller S, Schneider R, Haag G: Period prevalence of self-reported headache in the general population in Germany from 1995–2005 and 2009: Results from annual nationwide population-based cross-sectional surveys. J Headache and Pain 2013; 14: 11. CrossRef MEDLINE PubMed Central
30.Hagen K, Thoresen K, Stovner LJ, Zwart JA: High dietary caffeine consumption is associated with a modest increase in headache prevalence: results from the Head-HUNT Study. J Headache Pain 2009; 10: 153–9. CrossRef MEDLINE PubMed Central
31.Milde-Busch A, Blaschek A, Borggräfe I, Heinen F, Straube A, von Kries R: Associations of diet and lifestyle with headache in high-school students: results from a cross-sectional study. Headache 2010; 50: 1104–14. CrossRef MEDLINE
32.Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart JA: An unfavorable lifestyle and recurrent headaches among adolescents: the HUNT study. Neurology 2010; 75: 712–7. CrossRef MEDLINE
33. Aamodt AH, Stovner LJ, Hagen K, Bråthen G, Zwart J: Headache prevalence related to smoking and alcohol use. The Head-HUNT Study. Eur J Neurol 2006; 13: 1233–8. CrossRef MEDLINE
34.Hershey AD, Powers SW, Nelson TD, Kabbouche MA, Winner P, Yonker M, Linder SL, Bicknese A, Sowel MK, McClintock W: American Headache Society Pediatric Adolescent Section. Obesity in the pediatric headache population: a multicenter study. Headache 2009; 49: 170–7. CrossRef MEDLINE
35.Tietjen GE, Brandes JL, Peterlin BL, Eloff A, Dafer RM, Stein MR, Drexler E, Martin VT, Hutchinson S, Aurora SK, Recober A, Herial NA, Utley C, White L, Khuder SA: Childhood maltreatment and migraine (part I). Prevalence and adult revictimization: a multicenter headache clinic survey. Headache 2010; 50: 20–31. CrossRef MEDLINE
36.Pitrou I, Shojaei T, Chan-Chee C, Wazana A, Boyd A, Kovess-Masféty V: The associations between headaches and psychopathology: a survey in school children. Headache 2010; 50: 1537–48. CrossRef MEDLINE
37.Williams K, Chambers M, Logan S, Robinson D: Association of common health symptoms with bullying in primary school children. BMJ 1996; 313: 17–9. CrossRef MEDLINE
38.Due P, Holstein BE, Lynch J, Diderichsen F, Gabhain SN, Scheidt P, Currie C: Health Behaviour in School-Aged Children Bullying Working Group. Bullying and symptoms among school-aged children: international comparative cross sectional study in 28 countries. Eur J Public Health 2005; 15: 128–32. CrossRef MEDLINE
39.Bonfert M, Straube A, Schroeder AS, Reilich P, Ebinger F, Heinen F: Primary headache in children and adolescents: update on pharmacotherapy of migraine and tension-type headache. Neuropediatrics 2013; 44: 3–19. CrossRef MEDLINE
40.Evers S, Kropp P, Pothmann R, Heinen F, Ebinger F: Therapie idiopathischer Kopfschmerzen im Kindes- und Jugendalter. Nervenheilkunde 2008; 27: 1127–37.
e1.Alp R, Alp SI, Palanci Y, Sur H, Boru UT, Ozge A, Yapici Z: Use of the International Classification of Headache Disorders, Second Edition, criteria in the diagnosis of primary headache in schoolchildren: epidemiology study from eastern Turkey. Cephalalgia 2010; 30: 868–77. MEDLINE
e2.Karli N, Akgöz S, Zarifoðlu M, Akiþ N, Erer S: Clinical characteristics of tension-type headache and migraine in adolescents: a student-based study. Headache 2006; 46: 399–412. CrossRef MEDLINE
e3.Ando N, Fujimoto S, Ishikawa T, Teramoto J, Kobayashi S, Hattori A, Togari H: Prevalence and features of migraine in Japanese junior high school students aged 12–15 yr. Brain Dev 2007; 29: 482–5. CrossRef MEDLINE
e4.Gherpelli JL, Nagae Poetscher LM, Souza AM, Bosse EM, Rabello GD, Diament A, Scaff M: Migraine in childhood and adolescence. A critical study of the diagnostic criteria and of the influence of age on clinical findings. Cephalalgia 1998; 18: 333–41. CrossRef MEDLINE
e5.Krams B, Echenne B, Leydet J, Rivier F, Roubertie A: Benign paroxysmal vertigo of childhood: long-term outcome. Cephalalgia 2011; 31: 439–43. CrossRef MEDLINE
e6.Mazzotta G, Carboni F, Guidetti V, Sarchielli P, Feleppa M, Gallai V, Mastropaolo C, Puca F: Outcome of juvenile headache in outpatients attending 23 Italian headache clinics. Italian Collaborative Study Group on Juvenile Headache (Società Italiana Neuropsichiatria Infantile [SINPI]). Headache 1999; 39: 737–46. CrossRef MEDLINE
e7.Kienbacher C, Wöber C, Zesch HE, et al.: Clinical features, classification and prognosis of migraine and tension-type headache in children and adolescents: a long-term follow-up study. Cephalalgia 2006; 26: 820–30. CrossRef MEDLINE
e8.Arruda MA, Bigal ME: Behavioral and emotional symptoms and primary headaches in children: a population-based study. Cephalalgia 2012; 32: 1093–100. CrossRef MEDLINE
e9.Milde-Busch A, Boneberger A, Heinrich S, et al.: Higher prevalence of psychopathological symptoms in adolescents with headache. A population-based cross-sectional study. Headache 2010; 50: 738–48. CrossRef MEDLINE
e10.Balottin U, Poli PF, Termine C, Molteni S, Galli F: Psychopathological symptoms in child and adolescent migraine and tension-type headache: a meta-analysis. Cephalalgia 2013; 33: 112–22. CrossRef MEDLINE
e11.Pogliani L, Spiri D, Penagini F, Nello FD, Duca P, Zuccotti GV: Headache in children and adolescents aged 6–18 years in northern Italy: prevalence and risk factors. Eur J Paediatr Neurol 2011; 15: 234–40. CrossRef MEDLINE
e12.Bruijn J, Locher H, Passchier J, Dijkstra N, Arts WF: Psychopathology in children and adolescents with migraine in clinical studies: a systematic review. Pediatrics 2010; 126: 323–32. CrossRef MEDLINE
e13.Wang SJ, Juang KD, Fuh JL, Lu SR: Psychiatric comorbidity and suicide risk in adolescents with chronic daily headache. Neurology 2007; 68: 1468–73. CrossRef MEDLINE
e14.Lundqvist C, Clench-Aas J, Hofoss D, Bartonova A: Self-reported headache in schoolchildren: parents underestimate their children’s headaches. Acta Paediatr 2006; 95: 940–6. CrossRef MEDLINE
e15. Wager J, Hirschfeld G, Zernikow B: Tension-Type headache or migraine? Adolescents’ pain descriptions are of little help. Headache 2013; 53: 322–32. CrossRef MEDLINE
e16.Dooley JM, Gordon KE, Wood EP: Self-reported headache frequency in Canadian adolescents: validation and follow-up. Headache 2005; 45: 127–31. CrossRef MEDLINE
e17.Kernick D, Reinhold D, Campbell JL: Impact of headache on young people in a school population. Br J Gen Pract 2009; 59: 678–81. CrossRef MEDLINE PubMed Central
e18.Santinello M, Vieno A, De Vogli R: Primary headache in Italian early adolescents: the role of perceived teacher unfairness. Headache 2009; 49: 366–74. CrossRef MEDLINE
e19.Dyb G, Holmen TL, Zwart JA: Analgesic overuse among adolescents with headache: the Head-HUNT-Youth Study. Neurology 2006; 66: 198–201. CrossRef MEDLINE
e20.Santalahti P, Aromaa M, Sourander A, Helenius H, Piha J: Have there been changes in children’s psychosomatic symptoms? A 10-year comparison from Finland. Pediatrics 2005; 115: e434–42. CrossRef MEDLINE
e21.Linde M, Stovner LJ, Zwart JA, Hagen K: Time trends in the prevalence of headache disorders. The Nord-Trondelag Health Studies (HUNT 2 and HUNT 3). Cephalalgia 2011; 31: 585–96. CrossRef MEDLINE
e22.Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M: Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 2001; 41: 646–57. CrossRef MEDLINE
e23.Henry P, Auray JP, Gaudin AF, et al.: Prevalence and clinical characteristics of migraine in France. Neurology 2002; 59: 232–7. CrossRef MEDLINE
e24.Winter AC, Hoffmann W, Meisinger C, et al.: Association between lifestyle factors and headache. J Headache Pain 2011; 12: 147–55. CrossRef MEDLINE PubMed Central
e25.Linde M, Langnes HA, Hagen K, Bergh K, Stovner LJ: No increase in headache after previous intracranial infections: a historical cohort study (HUNT). Eur J Neurol 2012; 19: 324–31. CrossRef MEDLINE
e26.Milde-Busch A, von Kries R, Thomas S, Heinrich S, Straube A, Radon K: The association between use of electronic media and prevalence of headache in adolescents: results from a population-based cross-sectional study. BMC Neurol 2010; 10: 12. CrossRef MEDLINE PubMed Central
e27.Juang KD, Wang SJ, Fuh JL, Lu SR, Chen YS: Association between adolescent chronic daily headache and childhood adversity: a community-based study. Cephalalgia 2004; 24: 54–9. CrossRef MEDLINE
e28.Fuh JL, Wang SJ, Juang KD, Lu SR, Liao YC, Chen SP: Relationship between childhood physical maltreatment and migraine in adolescents. Headache 2010; 50: 761–8. CrossRef MEDLINE
e29.Tietjen GE, Brandes JL, Peterlin BL, et al.: Childhood maltreatment and migraine (part II). Emotional abuse as a risk factor for headache chronification. Headache 2010; 50: 32–41. CrossRef MEDLINE
e30.Tietjen GE, Brandes JL, Peterlin BL, et al.: Childhood maltreatment and migraine (part III). Association with comorbid pain conditions. Headache 2010; 50: 42–51. CrossRef MEDLINE
e31.Tietjen GE, Peterlin BL: Childhood abuse and migraine: epidemiology, sex differences, and potential mechanisms. Headache 2011; 51: 869–79. CrossRef MEDLINE
e32.Due P, Hansen EH, Merlo J, Andersen A, Holstein BE: Is victimization from bullying associated with medicine use among adolescents? A nationally representative cross-sectional survey in Denmark. Pediatrics 2007; 120: 110–7. CrossRef MEDLINE
e33.Bener A, Uduman SA, Qassimi EM, et al.: Genetic and environmental factors associated with migraine in schoolchildren. Headache 2000; 40: 152–7. CrossRef MEDLINE
e34.Milde-Busch A, Blaschek A, Heinen F, et al.: Associations between stress and migraine and tension-type headache: results from a school-based study in adolescents from grammar schools in Germany. Cephalalgia 2011; 31: 774–85. CrossRef MEDLINE
e35.Diener HC, Gaul C, Jensen R, Gobel H, Heinze A, Silberstein S: Integrated headache care. Cephalalgia 2011; 31: 1039–47. CrossRef MEDLINE
e36.Gaul C, van Doorn C, Webering N, et al.: Clinical outcome of a headache specific multidisciplinary treatment program and adherence to treatment recommendations in a tertiary headache center. An observational study. TJHP 2011; 12: 475–83. MEDLINE
e37.Göbel H, Heinze A, Heinze-Kuhn K, Henkel K, Roth A, Rüschmann HH: Entwicklung und Umsetzung der integrierten Versorgung in der Schmerztherapie. Das bundesweite Kopfschmerzbehandlungsnetz. Der Schmerz 2009; 23: 653–70. CrossRef MEDLINE
e38.Trautmann E, Kröner-Herwig B: A randomized controlled trial of Internet-based self-help training for recurrent headache in childhood and adolescence. Behav Res Ther 2010; 48: 28–37. CrossRef MEDLINE
e39.Gaul C, Totzeck A, Kraus U, Straube A: Kopfschmerz und Sport. Akt Neurol 2012; 39: 254–60. CrossRef
e40.Knook LM, Lijmer JG, Konijnenberg AY, Taminiau B, van Engeland H: The course of chronic pain with and without psychiatric disorders: a 6-year follow-up study from childhood to adolescence and young adulthood. J Clin Psychiatry 2012; 73: e134–9. CrossRef MEDLINE