Minna Aromaa

Determinants of tension-type headache in children.

The objective of this study was to study the prevalence, characteristics and predisposing factors of tension-type headache in children. An unselected population-based questionnaire study was carried out in 1409 Finnish schoolchildren aged 12 years. Of them, 1135 (81%) returned an acceptably completed questionnaire. The prevalence of episodic tension-type headache in children was 12% (138 of 1135). Children with episodic tension-type headache also often reported characteristics of pain typical for migraine. Children with frequent and persistent episodic tension-type headache reported stabbing and severe occipital pain, phonophobia and abdominal pain significantly more often than children with infrequent episodic tension-type headache. Neck-shoulder symptoms, symptoms of depression and oromandibular dysfunction were each independently associated with episodic tension-type headache. The fathers occupation of a lower-level white-collar worker put the child at a four-fold risk for episodic tension-type headache. We conclude that episodic tension-type headache is as common as migraine in children. It can be associated with depression, oromandibular dysfunction and muscular stress. Especially children with frequent and persistent episodic tension-type headache report characteristics of pain typical for migraine.

Childhood headache at school entry A controlled clinical study

Objective Our objective was to study the prevalence of different headache types, characterizations, and triggers of headache in Finnish children starting school. Methods Questionnaires were sent to 1,132 families with 6-year-old children. Children with headache disturbing their daily activities (n = 96) and an asymptomatic control group of children (n = 96) participated in a clinical interview and examination. Results Children with headache had significantly more bruxism (odds ratio [OR], 1.9; 95% CI, 1.0 to 3.4), tenderness in the occipital muscle insertion areas (OR, 4.8; 95% CI, 1.8 to 12.7), and tenderness in the temporomandibular joint areas (OR, 2.8; 95% CI, 1.3 to 6.0). They also had more travel sickness (OR, 3.4; 95% CI, 1.7 to 6.7) than control children. Eating ice cream (OR, 5.3; 95% CI, 1.4 to 20.31, fear (OR, 3.7; 95% CI, 1.2 to 11.21, and anxiety (OR, 3.2; 95% GI, 1.0 to 10.8) triggered headache more often in migraineurs than in children with tension-type headache. Children with migraine also reported more frequently abdominal (OR, 5.6; 95% CI, 1.7 to 18.1) and other (OR, 3.5; 95% CI, 1.2 to 9.8) pain concurrently with headache, and they used medication for pain relief more often (OR, 3.1; 95% CI, 1.0 to 9.5). Conclusions Headache classification in children may be improved by palpation of occipital muscle insertions and temporomandibular joint areas, and by discerning a history of triggering events and concurrent symptoms.

Pain Experience of Children With Headache and Their Families: A Controlled Study

Objective. This study reports the pain sensitivity of children with headache and their family members, as well as the prevalence of recurring aches, psychosocial life, and family environment of children with headache at preschool age. Design. A representative population-based sample of 1443 families expecting their first child were followed over 7 years. A screening questionnaire relating to the childs headache was sent to parents of a representative sample of 1132 6-year-old children. Of 144 children suffering from headache, 106 (76%) were examined and interviewed clinically. Ninety-six children with primary headache (58 migraine and 38 tension-type headache children) and matched controls (n = 96) were included in further examinations. Results. Children with headache were more often extremely sensitive to pain according to their parents, were more excited about physical examinations, cried more often during blood sampling or vaccination, avoided play or games more often because they were afraid of hurting themselves, and had recurring abdominal and growing pains more often than did control children. The fathers of children with headache were more often extremely sensitive to pain. Children with headache reacted with somatic symptoms, usually with pain and functional intestinal disorders in stress situations, felt more tired, and had more ideations of death during the previous month. They had also had more problems in day care and fewer hobbies such as scout or club meetings than did control children. More mothers of tension-type headache children than those of migraine children reported that they were considerably sensitive to pain. Tension-type headache children also had a poorer family environment; the family atmosphere was more often unhappy and the relationship between the parents was more often distant than in the families of children with migraines. Conclusions. In addition to somatic factors, it is important to consider the childs pain sensitivity, reaction to various stress situations, and family functioning when studying childhood headache. The childs coping mechanisms can be supported by information given by the parents. School entry can be considered a suitable period for careful investigation into possible occurrence of headache and also for giving information about headache and its management.

Factors of early life as predictors of headache in children at school entry

To study the main predictors of childhood preschool headache, 1443 families expecting their first child were followed from the onset of pregnancy to the childs sixth year of life. Subject selection was based on stratified randomized cluster sampling.

Cohort Profile: The STRIP Study (Special Turku Coronary Risk Factor Intervention Project), an Infancy-onset Dietary and Life-style Intervention Trial

It is now clear that atherosclerosis develops as a result of a life-long process often leading to coronary heart disease. Nutritional recommendations have been delivered to the general community to manage this epidemic. Since fat is an important source of energy and cholesterol is required for sex hormone synthesis, fears have emerged that low intake of saturated fat and cholesterol might influence children’s growth and development. Infants and young children have therefore been excluded from these nutritional recommendations. However, a number of arguments support the concept that prevention of children’s exposure to atherosclerosis risk factors should be started at an early age. Dietary fat intake and quality of fat regulate serum lipoprotein values in childhood in the same way as they do in adults. It has also been shown that children with high serum cholesterol and LDL cholesterol values are predisposed to early atherosclerotic changes in aorta and large arteries and high LDL cholesterol values in childhood associate with increased atherosclerotic changes in carotid arteries measured decades later. All these changes can be influenced by living habits. A lifestyle with emphasis on avoiding atherosclerosis risk factors might be most easily adopted if introduced in early childhood. A large cross-sectional coronary risk factor follow-up study, the Cardiovascular Risk in Young Finns (CRYF) has continued in Finland since 1980. In that study, an extensive number of atherosclerosis risk factors have been studied repeatedly in an initial cohort of 3596 individuals from age 3 years onwards. CRYF is a follow-up study without intervention, and a need for an interventional approach to control the coronary risk factors in childhood was evident. Finland is an ideal location to perform an atherosclerosis risk factor intervention study, since serum cholesterol values of Finnish boys have been high in international comparisons and, at the same time, coronary artery disease incidence in Finnish adults has also been very high. Moreover, the participation rate has by tradition been high in Finnish epidemiological trials. Due to these reasons, grant-funded Special Turku Coronary Risk Factor Intervention Project (STRIP) study was launched in 1989 to study whether it is possible to reduce exposure to coronary risk factors effectively and safely from early age on.

Muscle tenderness in pericranial and neck-shoulder region in children with headache. A controlled study

Increased pericranial muscle tenderness is connected with tension-type headache in adults. In children, the importance of muscle tenderness in the pericranial or neck-shoulder region in the pathogenesis of different types of headache is unknown. The present study evaluated muscle tenderness in the pericranial and neck-shoulder region in children with migraine, those with tension-type headache and those without headache. An unselected population-based questionnaire study concerning headache was carried out in 1135 Finnish schoolchildren aged 12 years. Of them, 183 children were randomly selected for a face-to-face interview and a clinical examination. Muscle tenderness was recorded by manual palpation and dolorimeter. Children with migraine had increased overall tenderness, recorded by manual palpation, compared with those without headache. They also self-reported tenderness in the neck-shoulder region during daily activities more often than the children of the other groups. Muscle tenderness was not associated with paediatric tension-type headache. The mean pressure pain thresholds did not differ among the three groups. However, a negative correlation between the total tenderness score and the dolorimeter score was found in each group. In conclusion, children with migraine had increased muscle tenderness at palpation of the pericranial and neck-shoulder muscles and they also reported pain symptoms in the neck-shoulder region most frequently. Instead, increased pericranial and neck-shoulder muscle tenderness was not associated with tension-type headache in children.

Headache children with temporomandibular disorders have several types of pain and other symptoms.

The aim was to investigate the association between temporomandibular disorders (TMD) and overall muscle tenderness, depressive symptoms, sleep difficulties, headache frequency and related symptoms in children with primary headache in comparison with controls. Based on an unselected population sample of 1135 Finnish schoolchildren classified according to the type of headache at age 12, altogether 297 children aged 13-14 from different headache groups and healthy controls were randomly selected for an interview and clinical examinations. Children with migraine had more TMD signs than children with nonmigrainous headaches or healthy controls. High TMD total scores were associated with palpation tenderness in other parts of the body and with frequent headache attacks. We conclude that children with overall headache, migraine in particular, and high total TMD scores showed an increased overall tenderness to muscle palpation and multiply manifested hypersensitivity pain.

Changing headache from preschool age to puberty. A controlled study

The characteristics of disturbing primary headache and the occurrence of headache types were studied by sending a questionnaire to 1132 Finnish families of 6-year-old children. Children with headache in the preceding 6 months and their controls were clinically examined at the ages of 6 and 13. During the follow-up, half of the headaches, classified as migraine at age 6 years, were unchanged and 32% turned into tension-type headache. In children with tension-type headache, the situation was unchanged in 35%, and in 38% of children the headache type had changed to migraine. At preschool age the most common location of headache was bilateral and supraorbital, and at puberty bilateral and temporal. During the follow-up, symptoms concurrent with headache, such as odour phobia, dizziness and balance disturbances became more typical, whereas restlessness, flushing and abdominal symptoms became less marked. The early manifestation of both migraine and tension-type headache predict equally often migraine in puberty with marked changes in concurrent symptoms and pain localization.

Extracephalic tenderness and pressure pain threshold in children with headache

Background Sensitisation of the pain detection system has been suggested to be involved in the pathogenesis of recurrent headache. In adults, increased sensitivity to pain has been found in patients with chronic tension type headache. Children with migraine or with unspecific headache report non‐headache pains and interictal pericranial muscular tenderness more often than headache‐free children.

Early Childhood Psychological Problems Predict a Poor Sense of Coherence in Adolescents: A 15-year Follow-up Study

The aim of the present 15-year follow-up was to study the association between childhood psychological symptoms and sense of coherence (SOC) in adolescence. Destructive behaviour at three years, attention problems and thought problems at 12 years, attention problems, anxiety/depression, delinquency and somatic complaints at 15 years predicted a poor SOC at 18 years. Problems reported by adolescents themselves explained a poor SOC much more often than problems reported by parents. The identification of early childhood behavioural problems helps us to identify children at risk of ill-being in adolescence since problems seem to persist unchanged until that period of life.