Pirjo Anttila

Psychiatric symptoms in children with primary headache.

OBJECTIVEnTo examine the association of psychiatric symptoms with migraine and tension-type headache in children.nnnMETHODnA questionnaire completed by 1,135 Finnish children in the sixth grade identified 154 children with migraine, 138 with tension-type headache, and 407 children who were headache-free. Seventy children were randomly selected from each group and evaluated by a structured interview to confirm headache type, resulting in a sample of 59 children with migraine, 65 with tension-type headache, and 59 without headache. The children completed the Childrens Depression Inventory, and the parents completed the Child Behavior Checklist and General Functioning scale of the McMaster Family Assessment Device.nnnRESULTSnChildren with migraine had significantly higher levels of total, internalizing, and somatic symptoms, as well as social and family problems, than those without headache and had higher levels of somatic symptoms than children with tension-type headache. Children with tension-type headache had significantly higher levels of somatic symptoms and family problems than those without headache.nnnCONCLUSIONSnThe association between psychiatric symptoms and headaches shows differences between different headache types. However, a minority of children with migraine or tension-type headache have high levels of psychiatric symptoms.

Long-term trends in the incidence of headache in Finnish schoolchildren.

OBJECTIVE. To study changes over time in the incidence of migraine and frequent headache. METHODS. A population-based study on migraine and other headaches in Finnish children starting school at age 7 years in the city of Turku was conducted in 1974, 1992, and 2002. The study design used in each study was virtually identical. The study population included 1927 children in 1974, 1436 children in 1992, and 1066 children in 2002. The corresponding response rates were 90%, 96%, and 81%. RESULTS. An increasing trend in the incidence of migraine was found from 1974 to 2002 in both boys and girls. The incidence rates of migraine with aura increased from 5.2 per 1000 person-years in 1974 to 41.3 per 1000 person-years in 2002. The increase in the rates of migraine without aura was from 14.5 per 1000 person-years in 1974 to 91.9 in 2002. Similarly, a significant increase over time was seen in the incidence of frequent headache from 1974 to 2002 in both boys and girls. CONCLUSIONS. The incidence of childhood migraine and frequent headache has substantially increased over the last 30 years. The increased incidence is alarming and reflects untoward changes in childrens lifestyles. Additional studies are needed on causal associations with life changes.

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.

Force production and EMG activity of neck muscles in adolescent headache.

Purpose. This study compared the maximal force, EMG/force ratio and co-activation characteristics of the neck-shoulder muscles between 30 adolescents with migraine-type headache, 29 with tension-type headache, and 30 headache-free controls. Method. Force was measured with surface electromyography (EMG) from the cervical erector spinae (CES), the sternocleidomastoid (SCM) and trapezius muscles during the maximal isometric neck flexion, neck extension and shoulder flexion. Results. Girls with migraine-type headache had higher EMG/force ratios between the EMG of the left agonist SCM muscle and the corresponding maximal neck flexion (p = 0.030) and neck rotation force to the right side (p = 0.024) than the girls with tension-type headache. Migrainous girls had more co-activation of right antagonist CES muscle during maximal neck flexion force than the girls without headache (p = 0.015). Neck force production showed no significant differences between girls. Girls with tension-type headache displayed lower left shoulder flexion force than girls with migraine-type headache (p = 0.005) or with no headache (p = 0.005). In boys, no significant differences were observed. Conclusions. Girls with tension-type headache and migraine-type headache have differences in neuromuscular function in the neck-shoulder muscles. The data amplify our knowledge of the neck-shoulder muscle dysfunction in adolescent headache, and may encourage the use of specific rehabilitation methods in the management of different types of headache.

Neck flexor muscle fatigue in adolescents with headache – An electromyographic study

Background: Muscular disorders of the neck region may be of importance for the etiology of tension‐type headache. However, in adolescents, there are no data on the association between neck muscle fatigue and headache.

Neck muscles cross‐sectional area in adolescents with and without headache – MRI study

Background: Cervical musculature may play an important role in the genesis of tension‐type headache. However, there are no reports on a possible association between the morphometrical features of the neck flexion and extension muscles and adolescence headache.

Familial occurrence of signs of temporomandibular disorders in headache children and their mothers

Objective. Earlier studies have provided evidence of genetic inheritance of headache, especially migraine, but no familial occurrence has been found regarding temporomandibular disorders (TMD). In adults, headache and TMD have been found to be associated with each other, but studies on children are few. The aim of the present study was to test the hypothesis that there is no association between signs of TMD in 13-year-old headache children and their mothers. Material and methods. The study population was a nested case-control study of the population-based Finnish Family Competence Study originally consisting of over 1000 families. A structured questionnaire was sent to the families of 6-year-old children. A clinical examination was performed in 96 children with headache and 96 pairwise controls. At the age of 13 years, 75 of these same 96 children with headache and 79 of 96 headache-free controls participated in pediatric and stomatognathic examinations. Moreover, the mothers (n=154) filled in a structured headache questionnaire and participated in the stomatognathic examination. Results. No association between mothers and childs TMD signs was found. There was a significant association between signs of TMD and both migraine and tension-type headache in children. In mothers, the association was significant only between migraine and TMD signs. Conclusions. Familial occurrence of signs of TMD cannot be found in headache children and their mothers.

Prevalence and Incidence of Headache in Adolescent Finnish Twins

Objectives.— The study aim was to determinate changes in prevalence and incidence rates of headache among adolescent Finnish twins.

Strength and mobility of the neck-shoulder region in adolescent headache

The significance of the musculoskeletal function of the neck-shoulder region in different headache types in children and adolescents is not clear. The purpose of this study was to investigate the association between different types of headache and the strength and mobility of the neck-shoulder region in 13-year-old schoolchildren. A structured questionnaire on headache was sent to all 1,409 children in the sixth grade in the city of Turku. Of the 1,135 (81%) children who completed the questionnaire, a sample from different headache groups was randomly selected for clinical examination. The study consisted of 59 children with migraine, 65 with episodic tension-type headache (TTHA), and 59 headache-free controls. Dynamic muscle strength of the upper extremities (UE endurance), mobility of both shoulders (UE mobility), and the cervical range of motion (CROM) were measured. Girls with episodic TTHA had lower UE endurance of both dominant and nondominant sides than girls in the other study groups. Girls with migraine had lower UE endurance of nondominant side than girls in the control group. In boys, no significant differences were observed. An interesting association between the function of the neck-shoulder region and headache complaints in adolescents was ascertained.

Adolescent cervical disc degeneration in MRI does not predict adult headache or neck pain: A 5-year follow-up of adolescents with and without headache

Aim The impact of early degenerative changes of the cervical spine on pain in adulthood is unknown. The objective was to determine whether degeneration in adolescence predicts headache or neck pain in young adulthood. Methods As part of a follow-up of schoolchildren with and without headache, 17-year-old adolescents with headache at least three times a month (Nu2009=u200947) and adolescents with no headache (Nu2009=u200922) participated in a magnetic resonance imaging (MRI) study of the cervical spine. The same adolescents were re-examined by phone interview at the age of 22 years (Nu2009=u200960/69, 87%). Results Mild disc degeneration at the age of 17 years was common, but was not associated with either frequent or intensive headache or neck pain at the age of 22 years. Conclusion: Mild degenerative changes of the cervical spine in 17-year-old adolescents cannot be regarded as a cause of future headache or neck pain.