Pediatric Headache Experience During the COVID-19 Pandemic

OBJECTIVE: Headache disorders are exceedingly common in children and adolescents. The association between headaches, emotional stress, and disruptions in daily routines are well established. The goal of this study is to compare the experiences of patients with a preexisting diagnosis of a primary headache disorder in terms of headache frequency and severity, lifestyle techniques for headache prevention, screen use, and mood from before and after the onset of the COVID-19 pandemic. METHODS: Patients evaluated by the Headache Clinic at Children\u27s National Hospital between Summer 2020 and Winter 2021 were enrolled in a patient registry. Patients completed a questionnaire examining changes in headache characteristics and lifestyle factors since the onset of the COVID-19 pandemic. RESULTS: A total of 107 patients completed the survey. Since the pandemic\u27s onset, patients reported decreased physical activity (n = 59, 55%), increased frequency of chronic headaches from 40% (N = 42) to 50% (N = 54), and increased constant daily headaches from 22% (n = 24) to 36% (n = 38). Patients reported worsened anxiety (n = 58, 54%), mood (n = 50, 47%), and workload (n = 49, 46%). Sixty-one percent (n = 65) of patients reported using screens for school for more than 6 hours per day. The majority (n = 67, 63%) of patients indicated that they would prefer attending in-person school, with 14% (n = 15) responding that they preferred online school. CONCLUSION: Since the COVID-19 pandemic\u27s onset, pediatric headache patients have experienced increasing headache frequency, worsening anxiety and mood, decreased physical activity, and increased screen usage. Although this study is limited by sample size and observational design, future population-based studies will further elucidate the impact of this pandemic on pediatric headache

Pediatric screen exposure and school related headache disability

BACKGROUND AND OBJECTIVES: Prolonged screen exposure is often cited as a trigger for pediatric headache. We present initial findings evaluating the association between adolescent screen use type, duration, and school disability. METHODS: New patients aged 12-17 years presenting to a headache clinic were screened and surveyed regarding headache characteristics, behavioral habits, school attendance, and screen utilization. RESULTS: 99 adolescents (29 M, 70 F) with average age 14.8 years and average headache frequency of 17 days per month completed the survey. Patients missed an average of five full days and three partial days of school due to headaches over the 90 days prior to survey completion.No statistically significant correlation was found between type or duration of screen exposure and monthly headache frequency, school attendance, or school functioning. A small positive association was seen between increasing duration of computer use, total hours screen use, and school absenteeism. While most adolescents reported prolonged screen use (58.6%) and luminosity (64.6%) worsened headaches, no statistical difference was seen in average number of headache days per month. CONCLUSIONS: Average monthly headache frequency in an adolescent population was not significantly correlated with type or duration of screen exposure. Further studies are needed to elucidate how screen utilization impacts school related headache disability

Natural History of Abortive Medication Withdrawal in the Management of Pediatric Medication Overuse Headache

OBJECTIVE: The objective of this study is to document pain scores during withdrawal of abortive medication in patients diagnosed with medication overuse headache. DESIGN: Cross-sectional study. SETTING: Children\u27s National Hospital\u27s Headache Program. SUBJECTS: Patients 6-18 years old who presented to the Headache Clinic at Children\u27s National Hospital with presumed medication overuse headache between March 2017 and March 2019 were consented for participation. METHODS: Patients were instructed to abruptly discontinue overused medications and record their headache characteristics daily in a diary for eight weeks. RESULTS: Fourteen diaries were returned and analyzed at a four-week follow-up visit. 93% of patients were females, with a median age of 14.9 years (SD = 2.0). The average headache intensity upon study entry was 4.7 of 10 (SD = 2.5) and was 3.1 (SD = 2.5) upon study completion. 57% had daily headaches upon study entry. 71% of patients had improved pain intensity from the first to last diary entry. 57% had complete headache resolution at an average of 7.6 days from medication discontinuation (SD = 5.1). Ibuprofen was the most overused medication (71%). CONCLUSIONS: Our findings suggest that medication overuse headache will improve in the majority of pediatric patients who abruptly stop the offending medication(s) in an average of eight days from withdrawal. Average pain intensity was reduced by more than one point among all patients who stopped taking abortive medications. Further larger scale studies on medication withdrawal in pediatric patients with medication overuse headache could help better understand if this management strategy is effective