title: What Factors Contribute to Headache-Related Disability in Teens?
abstract: BACKGROUND
  Our aim was to describe the relationship between risk factors, such as stress, depression, and anxiety, and potentially protective factors against pediatric headache-related disability, such as mindfulness, resilience, and self-compassion, and to determine teens' interest in mind-body skills training to help reduce headache-related disability.
  
  
  METHODS
  This was a cross-sectional survey among adolescents seen in an academic neurology clinic reporting four or more headaches monthly using standardized instruments to determine the relationship between putative risk and protective factors as well as physiologic markers of inflammation and vagal tone and headache-related disability.
  
  
  RESULTS
  Among the 29 participants, 31% were male, the average age was 14.8 years, average headache frequency was 11.6 per month, and the most commonly reported trigger was stress (86%). The only risk or protective factor significantly associated with headache-related disability was depression (r = 0.52, P = 0.004). Depression was negatively correlated with mindfulness, resilience, and self-compassion (P < 0.01 each) and positively correlated with stress, sleep disturbance, and anxiety (P < 0.01 each). Biomarkers of vagal tone and inflammation were correlated with each other but not with headache-related disability or depression. There was strong interest in learning skills like slow, deep breathing practices supported by a smart phone application to reduce stress and the negative impact of headaches on daily life.
  
  
  CONCLUSIONS
  Among teens with frequent migraine headaches, depression is the strongest risk factor for headache-related disability. Stress is viewed as a headache trigger, and teens reported wanting to learn simple stress management strategies supported by a smart phone application to help reduce headache-related disability.
authors.affiliation: Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Center for Integrative Health and Wellness, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio. Electronic address: Kathi.kemper@osumc.edu.
authors.forename: Kathi J
authors.initials: KJ
authors.lastname: Kemper
authors.affiliation: Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Center for Integrative Health and Wellness, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Neurology, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Heyer
authors.affiliation: Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Center for Integrative Health and Wellness, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Neurology, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Ann
authors.initials: A
authors.lastname: Pakalnis
authors.affiliation: Center for Integrative Health and Wellness, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; Department of Medicine, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Philip F
authors.initials: PF
authors.lastname: Binkley
mesh_terms: D000293:Adolescent; D003402:Creatine Kinase / Q000097:blood; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D019988:Children with Disabilities; D004562:Electrocardiography; D005260:Female; D006261:Headache / Q000150:complications*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D064866:Mindfulness; D019964:Mood Disorders / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D064232:Visual Analog Scale
chemical_list: D015850:Interleukin-6; D003402:Creatine Kinase
keywords: anxiety; depression; headache; heart rate variability; migraine; pediatric; stress
references.citation: Sleep. 2010 Jun;33(6):781-92
references.pmid: 20550019
references.citation: J Telemed Telecare. 2008;14(2):88-92
references.pmid: 18348755
references.citation: Health Qual Life Outcomes. 2012 Feb 22;10:22
references.pmid: 22357192
references.citation: J Sport Rehabil. 2011 Feb;20(1):129-42
references.pmid: 21411828
references.citation: J Health Soc Behav. 1983 Dec;24(4):385-96
references.pmid: 6668417
references.citation: Dev Med Child Neurol. 2010 Dec;52(12):1088-97
references.pmid: 20875042
references.citation: Cephalalgia. 2014 May;34(6):455-63
references.pmid: 24366979
references.citation: Anxiety Stress Coping. 2011 Mar;24(2):227-33
references.pmid: 20865588
references.citation: J Korean Med Sci. 2009 Oct;24(5):936-40
references.pmid: 19794995
references.citation: Int J Yoga. 2014 Jul;7(2):126-32
references.pmid: 25035622
references.citation: Cephalalgia. 2011 Feb;31(3):357-67
references.pmid: 20819842
references.citation: J Pain Symptom Manage. 2012 Apr;43(4):759-70
references.pmid: 22071165
references.citation: Headache. 2008 May;48(5):735-6; discussion 736-7
references.pmid: 18471128
references.citation: Can Fam Physician. 2014 Mar;60(3):244-6
references.pmid: 24627379
references.citation: Am J Clin Hypn. 2011 Jul;54(1):32-46
references.pmid: 21922710
references.citation: Headache. 2014 Feb;54(2):325-34
references.pmid: 24512577
references.citation: Semin Neurol. 2006 Apr;26(2):199-207
references.pmid: 16628530
references.citation: J Headache Pain. 2014 Sep 10;15:60
references.pmid: 25205384
references.citation: BMC Pregnancy Childbirth. 2010 Nov 03;10:72
references.pmid: 21047418
references.citation: Cereb Cortex. 2012 Nov;22(11):2692-702
references.pmid: 22172578
references.citation: Neurol Clin. 2009 May;27(2):321-34
references.pmid: 19289218
references.citation: J Clin Epidemiol. 2006 Apr;59(4):374-80
references.pmid: 16549259
references.citation: Headache. 2013 May;53(5):799-816
references.pmid: 23594025
references.citation: Int J Behav Med. 2008;15(3):194-200
references.pmid: 18696313
references.citation: Headache. 2014 Oct;54(9):1484-95
references.pmid: 25041058
references.citation: J Headache Pain. 2013 Feb 14;14:12
references.pmid: 23565669
references.citation: JAMA. 2008 Sep 17;300(11):1350-2
references.pmid: 18799450
references.citation: Pediatrics. 2013 Nov;132(5):e1173-83
references.pmid: 24127466
references.citation: Complement Ther Med. 2015 Apr;23(2):149-56
references.pmid: 25847552
references.citation: Psychoneuroendocrinology. 2011 Jun;36(5):664-81
references.pmid: 21035949
references.citation: Headache. 2005 Jun;45(6):638-43
references.pmid: 15953295
references.citation: Headache. 2010 Feb;50(2):210-8
references.pmid: 19804389
references.citation: Pediatr Ann. 2004 Apr;33(4):241-5
references.pmid: 15101230
references.citation: Neurology. 2012 Oct 30;79(18):1881-8
references.pmid: 23109652
references.citation: J Neurosci. 2011 Apr 6;31(14):5540-8
references.pmid: 21471390
references.citation: Qual Life Res. 2010 May;19(4):595-607
references.pmid: 20213516
references.citation: Cephalalgia. 2012 Jul;32(9):710-4
references.pmid: 22707519
references.citation: Cephalalgia. 2014 Sep;34(10):833-45
references.pmid: 25078716
references.citation: Headache. 2011 May;51(5):693-706
references.pmid: 21521206
references.citation: Holist Nurs Pract. 2012 Sep-Oct;26(5):262-71
references.pmid: 22864296
references.citation: Headache. 2007 Jan;47(1):7-12
references.pmid: 17355488
references.citation: Clin Psychol Psychother. 2011 May-Jun;18(3):250-5
references.pmid: 21584907
references.citation: Headache. 2009 Nov-Dec;49(10):1486-92
references.pmid: 19486363
references.citation: Health Qual Life Outcomes. 2014 Aug 01;12:117
references.pmid: 25080874
references.citation: Headache. 2003 Jun;43(6):601-10
references.pmid: 12786918
references.citation: Brain Behav Immun. 2007 Nov;21(8):1038-49
references.pmid: 17521871
references.citation: Headache. 2004 Mar;44(3):217-22
references.pmid: 15012658
references.citation: J Altern Complement Med. 2011 Mar;17(3):213-8
references.pmid: 21348798