Behavior issues are a bigger headache for children with migraines

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, according to research out now in the journal Cephalagia.

Marco Arruda, director of the Glia Institute in São Paulo, Brazil, together with Marcelo Bigal of the Albert Einstein College of Medicine in New York studied 1,856 Brazilian children aged 5 to 11. The authors 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.

Children with or suffering from migraine had a much greater overall likelihood of abnormal behavioral scores than controls, especially in somatic, anxiety-depressive, social, attention, and internalizing domains. Children with TTH were affected in the same domains as migraine sufferers, but to a lesser degree.

The study used internationally validated headache questionnaires as well as the Child Behavior Checklist (CBCL) to assess emotional symptoms. The researchers trained school teachers in how to walk parents through questionnaires step by step.

For children with either migraine (23%) or TTH (29%), more frequent headaches correlated with increasingly abnormal scores on the behavior scale. The types of behavior most often seen were those characterized as internalizing – behaviors directed towards the self. While less than a fifth of controls (19% of sample) have issues with internalizing behaviors, over half of migraine sufferers were affected. Externalizing behaviors, such as becoming more aggressive or breaking rules, were no more likely among the children with frequent attacks of headache than among the controls. The researchers suggested the CBCL may be underpowered to investigate the correlation between attention/hyperactivity and headaches in detail.

"As previously reported by others, we found that migraine was associated with social problems," said Arruda. "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."

"Providers should be aware of this possibility in children with migraines, in order to properly address the problem," he added.

Previous research has pointed to children with migraine being more likely than their peers to have other physical or psychological issues, including anxiety, depression, and attention and hyperactivity problems. But until now, few studies have examined the contrasts between TTH in children. Including headache frequency was also a missing part of the puzzle, the authors say.

Children often suffer from headaches, with migraine prevalence ranging from just over three percent to over one fifth of children as they progress from early childhood through to adolescence.