title: The associations among childhood headaches, emotional and behavioral difficulties, and health care use.
abstract: BACKGROUND
  Headaches are common among children and adolescents, particularly migraine and tension-type headaches. They contribute to missed school days, affect children's peer and family relationships, and significantly impact children's quality of life, often times into adulthood.
  
  
  OBJECTIVE
  This study, based on responses to the Strengths and Difficulties Questionnaire, was designed to examine difficulties and impairments related to emotions, concentration, behavior, and social functioning among children with frequent or severe headaches (FSH).
  
  
  METHODS
  We used a cross-sectional study of 9264 children aged 4-17 years from the 2003 National Health Interview Survey, an ongoing, computer-assisted personal interview survey of the noninstitutionalized US population.
  
  
  RESULTS
  Approximately 6.7% of children experienced FSH during the previous 12 months. Overall, children with FSH were 3.2 times more likely than children without FSH to have a high level of difficulties and 2.7 times more likely to have a high level of impairment, suggesting potential mental health issues. More specifically, analyses revealed that children with FSH were significantly more likely than those without FSH to exhibit high levels of emotional, conduct, inattention-hyperactivity, and peer problems and were significantly more likely than children without FSH to be upset or distressed by their difficulties and to have their difficulties interfere with home life, friendships, classroom learning, and leisure activities.
  
  
  CONCLUSIONS
  Because children with FSH experience notable pain, mental health issues, and functional limitations, integrated care using a biopsychosocial approach is warranted.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. tws2@cdc.gov
authors.forename: Tara W
authors.initials: TW
authors.lastname: Strine
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Okoro
authors.forename: Lisa C
authors.initials: LC
authors.lastname: McGuire
authors.forename: Lina S
authors.initials: LS
authors.lastname: Balluz
mesh_terms: D000293:Adolescent; D002648:Child; D002652:Child Behavior; D002653:Child Behavior Disorders / Q000150:complications; D002675:Child, Preschool; D019260:Expressed Emotion; D005260:Female; D006261:Headache / Q000150:complications / Q000523:psychology* / Q000628:therapy; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D011788:Quality of Life; D013315:Stress, Psychological / Q000150:complications