Recurrent Headaches Shown to Affect Children's Quality of Life as Much as Other Chronic Diseases
Until recently, recurrent headaches in children and adolescents weren't regarded as an affliction that could affect a child's quality of life. However, a new study by Andrew Hershey, MD, PhD, et al, found that migraine headaches can affect children in very much the same way as other long-term illnesses. These results may be surprising, since as recently as 20 years ago, the widespread thinking was that children and teens did not get migraine headaches. Contributing to this falsehood is the fact that adults themselves often misdiagnose their own migraines as sinus headaches. According to Dr. Hershey, director of the Cincinnati Children's Headache Center, a shift in thinking needs to take place. The first step is recognizing that headaches in children and teens are a significant, real problem that need medical assessment and treatment.
Measuring the Results
Dr. Hershey collaborated on this study with Cincinnati Children's psychologists Scott Powers, PhD, co-director of the Headache Center; Susana Patton, PhD; and Kevin Hommel, PhD. The researchers sought not only to find out how daily headaches affect children's quality of life, but also to compare their findings to those of children with other chronic diseases.
"Migraines have as big an impact on quality of life as other chronic illnesses," says Dr. Hershey, who measured his quality of life results against those of children with arthritis and cancer. "Kids with migraines are affected just as badly." Using the Pediatric Quality of Life Inventory (PedsQL) form, Headache Center staff measured patients' physical health, psychosocial health, emotional functioning, social functioning and school functioning. In all cases, significant differences were reported for children with headaches as compared to healthy children.
Additionally, the scores of the headache patients were similar to those of children with rheumatoid conditions and cancer. These results suggest that full treatment of headaches should include not just a diagnosis, but also an evaluation of quality of life impact. His staff strives to provide such treatment. "Healthiness is measured by disability and quality of life, not just whether a patient has headaches or not," Dr. Hershey says.
A Collaborative Approach to Care
The Headache Center was established in 1996 to diagnose, treat and manage children and teens with headache disorders. The treatment provided in the Headache Center is the result of carefully orchestrated, multidisciplinary collaborations among neurologists, psychologists, nurse practitioners, nurses and research staff. "We're the largest pediatric headache center providing tertiary care in the world," Dr. Hershey says. "We are a clinical research unit with the sole purpose of making kids healthy." He expects the staff will see 700 new patients this year, while continuing to follow established patients.
Dr. Hershey emphasizes the use of appropriate tools to diagnose headaches and evaluate their effect on children's day-to-day activities. One such tool is the International Classification of Headache Disorders, 2nd Edition, used to standardize diagnoses. Another tool, which assesses disability, is one developed by Dr. Hershey's own team: Pediatric Migraine Disability Assessment, or PedMIDAS. This questionnaire measures the impact of patients' migraines and monitors treatment outcomes. It was adapted from the wellestablished MIDAS questionnaire, used to assess headache disability in adults. Tools like these help with better diagnosis and treatment of headaches, and should improve overall outcome.
Currently the Headache Center team is working on developing a questionnaire that could be used by pediatricians and school nurses to easily assess and diagnose childhood migraines.
Looking for More Answers
In addition to developing new diagnostic tools and measures, these investigators continue to perform other research to understand the cause of headaches in children. A recent study challenges the International Headache Society's criteria for migraine. Other research includes evaluating treatment strategies for children and teens with chronic daily headaches, studying the genomic expression in patients with headaches, examining vitamin deficiencies and performing drug studies.
Dr. Hershey is interested in all aspects of headache management in children. He believes effective diagnosis and quality of life assessment will lead to better outcomes and prevent the longterm suffering that many adults with migraine headaches experience. He envisions a combination of PedsQL and PedMIDAS would most effectively evaluate migraines and their impact on quality of life concurrently. "Having migraines isn't the only problem," Dr. Hershey says. "The disability and the impact of headaches on patients' lives also need to be addressed."
Dr. Hershey serves as director of the Cincinnati Children's Headache Center in the Division of Neurology and is associate professor of pediatrics and neurology. His study was published in Pediatrics (112[1]:E1-E5, 2003 July).
