title: Higher prevalence of psychopathological symptoms in adolescents with headache. A population-based cross-sectional study.
abstract: BACKGROUND
  Headache is commonly voiced by adolescents and is known to be associated with reduced quality of life. Otherwise, there are only limited data regarding associations between different types of headache and psychopathological symptoms in adolescents.
  
  
  OBJECTIVE
  Aim of the present study in adolescents was to assess the impact of headache on psychopathological symptoms and whether these differ between types of headache.
  
  
  METHODS
  Data were derived from a population-based sample (n = 1047, ages 13-17 years). Type of headache (ie, migraine, tension-type headache, miscellaneous headache) was ascertained for subjects reporting headache episodes at least once per month. Psychopathological symptoms were assessed with the Strengths and Difficulties Questionnaire. The following dimensions were taken into account: emotional symptoms, conduct problems, hyperactivity/inattention, peer problems (these 4 add to the total difficulties score), and prosocial behavior. Associations were estimated with logistic regression models with adjustment for age group, sex, and family situation.
  
  
  RESULTS
  Headache at least once per month was reported by 47.8% of the adolescents. Subjects with any headache were found to be at higher risk for emotional symptoms (odds ratio 1.5; 95% confidence interval 1.0-2.2) and hyperactivity/inattention (1.4; 1.0-1.9), resulting in a higher total difficulties score (1.6; 1.1-2.4). While the risk for psychopathological symptoms was not significantly increased in subjects with tension-type headache compared with subjects without headache, significant associations with emotional symptoms were found in subjects with migraine (2.9; 1.3-6.2; total difficulties score: 3.1; 1.4-6.8). Miscellaneous headache was associated with a broad spectrum of psychopathological symptoms: emotional symptoms (1.8; 1.0-3.3), conduct problems (1.6; 1.0-2.6), hyperactivity/inattention (1.9; 1.2-3.1), total difficulties score (2.7; 1.6-5.6).
  
  
  CONCLUSIONS
  Previously reported associations between headache and psychopathological symptoms in adolescents could be confirmed, but might vary with type of headache. As psychopathological symptoms may be a precursor for manifest psychiatric disorders, adolescents particularly with migraine and miscellaneous headache appear to be a vulnerable population.
authors.affiliation: From the Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Milde-Busch
authors.forename: Anja
authors.initials: A
authors.lastname: Boneberger
authors.forename: Sabine
authors.initials: S
authors.lastname: Heinrich
authors.forename: Silke
authors.initials: S
authors.lastname: Thomas
authors.forename: Anja
authors.initials: A
authors.lastname: Kühnlein
authors.forename: Katja
authors.initials: K
authors.lastname: Radon
authors.forename: Andreas
authors.initials: A
authors.lastname: Straube
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Kries
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D020773:Headache Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D012307:Risk Factors