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Pediatric Migraine and Academics

Abstract

Purpose of Review

The purpose of this review is to examine the multitude of factors which may impact learning and academic performance in patients with pediatric migraine.

Recent Findings

A range of associations of varying degree were noted between pediatric migraine and conditions such as ADHD, learning disabilities, sleep disorders, and psychiatric comorbidities with regard to headache pain and school functioning. Recent literature highlights the importance of sleep in relation to headache, mood disorders, and learning in youth and the emerging role of perfectionism.

Summary

Children with migraine remain at risk for school related and learning difficulties which may be primarily due to pain, due to other medical and psychiatric comorbidities commonly found in this population, or a combination. The relationships are complex and further studies are needed to clearly elucidate the shared biological and environmental pathophysiologic mechanisms.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Krogh AB, Larsson B, Linde M. Prevalence and disability of headache among Norwegian adolescents: A cross-sectional school-based study. Cephalalgia. 2015;35(13):1181–91. https://doi.org/10.1177/0333102415573512.

    Article  PubMed  Google Scholar 

  2. 2.

    Winner P, Hershey AD. Epidemiology and diagnosis of migraine in children. Curr Pain Headache Rep. 2007;11(5):375–82. https://doi.org/10.1007/s11916-007-0220-6.

    Article  PubMed  Google Scholar 

  3. 3.

    Powers SW, Patton SR, Hommel KA, Hershey AD. Quality of life in childhood migraines: clinical impact and comparison to other chronic illnesses. Pediatrics. 2003;112(1 Pt 1):e1–5. https://doi.org/10.1542/peds.112.1.e1.

    Article  PubMed  Google Scholar 

  4. 4.

    • Pawlowski C, Buckman C, Tumin D, Smith A, Crotty J. National trends in pediatric headache and associated functional limitations. Clin Pediatr. 2019;58(14):1502–8. https://doi.org/10.1177/0009922819875560Analysis of National Health Interview Survey data showing correlation between headache and functional disability in pediatrics.

    Article  Google Scholar 

  5. 5.

    Jameson N, Sheppard B, Lateef T, Vande Voort J, He J, Merikangas K. Medical comorbidity of attention-deficit/hyperactivity disorder in US adolescents. J Child Neurol. 2016;31(11):1282–9. https://doi.org/10.1177/0883073816653782.

    Article  PubMed  Google Scholar 

  6. 6.

    •• Arruda M, Arruda R, Guidetti V, Bigal M. ADHD is comorbid to migraine in childhood: a population-based study. J Atten Disord. 2017. https://doi.org/10.1177/1087054717710767Cross sectional study of a national dataset showing the comorbidity of chronic and episodic migraine with ADHD.

  7. 7.

    Arruda M, Arruda R, Guidetti V, Bigal M. Psychosocial adjustment of children with migraine and tension-type headache - a nationwide study. Headache. 2015;55:39–50. https://doi.org/10.1111/head.12510.

    Article  PubMed  Google Scholar 

  8. 8.

    • Salem H, Vivas D, Cao F, Kazimi I, Teixeira A, Zeni C. ADHD is associated with migraine: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry. 2017;27(3):267–77. https://doi.org/10.1007/s00787-017-1045-4A large systematic review which failed to show a significant association between ADHD and headaches.

    Article  PubMed  Google Scholar 

  9. 9.

    Genizi J, Gordon S, Kerem N, Srugo I, Shahar E, Ravid S. Primary headaches, attention deficit disorder and learning disabilities in children and adolescents. J Headache Pain. 2013;14:54. https://doi.org/10.1186/1129-2377-14-54.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Arruda M, Guidetti V, Galli F, Albuquerque R, Bigal M. Migraine, tension-type headache, and attention-deficit/hyperactivity disorder in childhood: a population-based study. Postgrad Med. 2010;122(5):18–26. https://doi.org/10.1177/1087054717710767.

    Article  PubMed  Google Scholar 

  11. 11.

    • Kutuk M, Tufan A, Guler G, Yalin O, Altintas E, Bag H, et al. Migraine and associated comorbidities are three times more frequent in children with ADHD and their mothers. Brain Dev. 2018;40(10):857–64. https://doi.org/10.1016/j.braindev.2018.06.001Cross sectional study showing a strong bidirectional relationship between ADHD and primary headache disorders.

    Article  PubMed  Google Scholar 

  12. 12.

    Fluegge K, Fluegge K. ADHD and comorbid migraine. Epilepsy Behav. 2018;80:378–9. https://doi.org/10.1016/j.yebeh.2017.12.029.

    Article  PubMed  Google Scholar 

  13. 13.

    Genizi J, Khourieh Matar A, Schertz M, Zelnik N, Srugo I. Pediatric mixed headache -the relationship between migraine, tension-type headache and learning disabilities - in a clinic-based sample. J Headache Pain. 2016;17(1).

  14. 14.

    Carskadon MA. Sleep’s effects on cognition and learning in adolescence. Prog Brain Res. 2011;190:137–43. https://doi.org/10.1016/B978-0-444-53817-8.00008-6.

    Article  PubMed  Google Scholar 

  15. 15.

    Dewald JF, Meijjer AM, Oort FJ, Kerkhof GA, Bogels SM. The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review. Sleep Med Rev. 2010;14(3):179–89. https://doi.org/10.1016/j.smrv.2009.10.004.

    Article  PubMed  Google Scholar 

  16. 16.

    •• Lateef T, Witonsky K, He J, Ries Merikangas K. Headaches and sleep problems in US adolescents: findings from the National Comorbidity Survey-Adolescent Supplement (NCS-A). Cephalalgia. 2019;39(10):1226–35. https://doi.org/10.1177/0333102419835466Cross-sectional population-based study evaluating associations between sleep patterns, sleep disorders, and headache subtypes in US adolescents.

    Article  PubMed  Google Scholar 

  17. 17.

    Rabner J, Kaczynski KJ, Simons LE, LeBel A. Pediatric headache and sleep disturbance: a comparison of diagnostic groups. Headache. 2018;58(2):217–28. https://doi.org/10.1111/head.13207.

    Article  PubMed  Google Scholar 

  18. 18.

    Simpson NS, Scott-Sutherland J, Gautam S, Sethna N, Haack M. Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain. 2018;159(1):33–40. https://doi.org/10.1097/j.pain.0000000000001053.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Foundation NS. 2006 sleep in America poll [May 18, 2014]: 2006. Available from http://sleepfoundation.org/sites/default/files/2006_summary_of_findings.pdf.

    Google Scholar 

  20. 20.

    Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Med Rev. 2015;21:50–8. https://doi.org/10.1016/j.smrv.2014.07.007.

    Article  PubMed  Google Scholar 

  21. 21.

    Gooley JJ, Chamberlain K, Smith KA, Khalsa SB, Rajaratnam SM, Van Reen E, et al. Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. J Clin Endocrinol Metab. 2011;96(3):E463–72. https://doi.org/10.1210/jc.2010-2098.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Montagni I, Guichard E, Carpenet C, Tzourio C, Kurth T. Screen time exposure and reporting of headaches in young adults: a cross-sectional study. Cephalalgia. 2016;36(11):1020–7. https://doi.org/10.1177/0333102415620286.

    Article  PubMed  Google Scholar 

  23. 23.

    Stiglic N, Viner RM. Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews. BMJ Open. 2019;9(1):e023191. https://doi.org/10.1136/bmjopen-2018-023191.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Langdon R, Cameron M, Strelzik J, DiSabella M. Pediatric screen exposure and headache disability. Headache. 2019;59(1):75. https://doi.org/10.1111/head.13549.

    Article  Google Scholar 

  25. 25.

    •• Gelfand AA, Pavitt S, Greene K, Szperka CL, Szperka CL, Iriwn S, et al. High school start time and migraine frequency in high school students. Headache. 2019;59(7):1024–31. https://doi.org/10.1111/head.13535Cross-sectional observational study of US high school students with migraine evaluating migraine frequency in relation to school start time.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Torres-Ferrus M, Vila-Sala C, Quintana M, Ajanovic S, Gallardo VJ, Gomez JB, et al. Headache, comorbidities and lifestyle in an adolescent population (the TEENs study). Cephalalgia. 2019;39(1):91–9. https://doi.org/10.1177/0333102418777509.

    Article  PubMed  Google Scholar 

  27. 27.

    Rains JC. Sleep and migraine: assessment and treatment of comorbid sleep disorders. Headache. 2018;58(7):1074–91. https://doi.org/10.1111/head.13357.

    Article  PubMed  Google Scholar 

  28. 28.

    Beesdo K, Knappe S, Pine DS. Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatr Clin North Am. 2009;32(3):483–524. https://doi.org/10.1016/j.psc.2009.06.002.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Dick BD, Pillai Riddell RR. Cognitive and school functioning in children and adolescents with chronic pain: a critical review. Pain Res Manag. 2010;15(4):238–44. https://doi.org/10.1155/2010/354812.

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Ginsburg GS, Riddle MA, Davies M. Somatic symptoms in children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2006;45(10):1179–87. https://doi.org/10.1097/01.chi.0000231974.43966.6e.

    Article  PubMed  Google Scholar 

  31. 31.

    • Machnes-Maayan D, Elazar M, Apter A, Zeharia A, Krispin O, Eidlitz-Markus T. Screening for psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain. Pediatr Neurol. 2016;50(1):49–56 Study demonstrating children referred to specialized outpatient pediatric units for evaluation of recurrent pain are high risk of psychiatric comorbidity.

    Article  Google Scholar 

  32. 32.

    •• Blaauw BA, Dyb G, Hagen K, Holmen TL, Wentzel-Larsen T, Zwart JA. The relationship of anxiety, depression and behavioral problems with recurrent headache in late adolescence: a Young-HUNT follow-up study. J Headache Pain. 2015;16(10). https://doi.org/10.1186/1129-2377-16-10A large longitudinal study of adolescents in Norway with headaches evaluating the comorbidity of various emotional and behavioral conditions.

  33. 33.

    • Fielding J, Young S, Martin PR, Waters AM. Headache symptoms consistent with migraine and tension-type headaches in children with anxiety disorders. J Anxiety Disord. 2016;40:67–74. https://doi.org/10.1016/j.janxdis.2016.04.006Survey study showing children with anxiety disorders had a higher incidence of headache symptoms consistent with migraine and TTH compared to children without anxiety disorders.

    Article  PubMed  Google Scholar 

  34. 34.

    O’Brian H, Slater S. Comorbid psychological conditions in pediatric headache. Semin Pediatr Neurol. 2016;23(1):68–70. https://doi.org/10.1016/j.spen.2016.01.002.

    Article  Google Scholar 

  35. 35.

    Balottin U, Poli P, Termine C, Molteni S, Molteni S, Galli F. Pathological symptoms in child and adolescent migraine and tension-type headache: a meta-analysis. Cephalalgia. 2013;33(2):112–22. https://doi.org/10.1177/0333102412468386.

    Article  PubMed  Google Scholar 

  36. 36.

    Mclean CP, Asnaani A, Litz BT, Hoffman SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45(8):1027–35. https://doi.org/10.1016/j.jpsychires.2011.03.006.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Marziniak M, Mossner R, Schmitt A, Lesch KP. A functional serotonin transporter gene polymorphism is associated with migraine with aura. Neurology. 2005;64(1):157–9. https://doi.org/10.1212/01.WNL.0000148597.52312.9E.

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Strug LJ, Suresh R, Fyer AJ, Talati A, Adams PB, Li W, et al. Panic disorder is associated with the serotonin transporter gene but not the promoter region. Mol Psychiatry. 2010;15(2):166–76. https://doi.org/10.1038/mp.2008.79.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Zwangzer P, Rupprecht R. Selective GABAergic treatment for panic? Investigations in experimental panic induction and panic disorder. J Psychiatry Neurosci. 2005;30(3):167.

    Google Scholar 

  40. 40.

    D’Andrea G, Granella F, Cataldini M, Verdelle F, Balbi T. GABA and glutamate in migraine. J Headache Pain. 2001;2(1):57–60. https://doi.org/10.1007/s101940170011.

    Article  Google Scholar 

  41. 41.

    Baskin SM, Smitherman TA. Migraine and psychiatric disorders: comorbidities, mechanisms, and clinical implications. Neurol Sci. 2009;30(1):61–5. https://doi.org/10.1007/s10072-009-0071-5.

    Article  Google Scholar 

  42. 42.

    •• Dyb G, Stensland S, Zwart J. Psychiatric comorbidity in childhood and adolescent headache. Curr Pain Headache Rep. 2015;19(3). https://doi.org/10.1007/s11916-015-0479Summary of clinical and epidemiological evidence for psychiatric comorbidity in pediatric headache including discussion of shared pathophysiologic mechanisms and approach to care.

  43. 43.

    Crombez G, Eccleston C, Van Damme S, Vlaeyen JW, Karoly P. Fear-avoidance model of chronic pain. Clin J Pain. 2012;28(6):475–83. https://doi.org/10.1097/AJP.0b013e3182385392.

    Article  PubMed  Google Scholar 

  44. 44.

    Straube A, Heinen F, Ebinger F, von Kries R. Headache in school children: prevalence and risk factors. Dtsch Arztebl Int. 2013;110(48):811–8. https://doi.org/10.3238/arztebl.2013.0811.

    Article  PubMed  PubMed Central  Google Scholar 

  45. 45.

    •• Tietjen GE, Brandes JL, Peterlin BL, Eloff A, Dafer RM, Stein MR, et al. Childhood maltreatment and migraine (part I). Prevalence and adult revictimization: a multicenter headache clinic survey. Headache. 2010;50(1):20–31. https://doi.org/10.1111/j.1526-4610.2009.01556Multicenter headache clinic study evaluating the relationship of childhood abuse and neglect with migraine.

    Article  PubMed  Google Scholar 

  46. 46.

    •• Tietjen GE, Brandes JL, Peterlin BL, Eloff A, Dafer RM, Stein MR, et al. Childhood maltreatment and migraine (part II). Emotional abuse as a risk factor for headache chronification. Headache. 2010;50(1):32–41. https://doi.org/10.1111/j.1526-4610.2009.01557Multicenter headache clinic study evaluating the relationship of childhood abuse and neglect with migraine.

    Article  PubMed  Google Scholar 

  47. 47.

    • Gini G, Pozzoli T, Lenzi M, Vieno A. Bullying victimization at school and headache: a meta-analysis of observational studies. Headache. 2014;54(6):976–86. https://doi.org/10.1111/head.12344Meta-analysis demonstrating an association between bullying victimization and youth headache.

    Article  PubMed  Google Scholar 

  48. 48.

    Lazarus RS. Psychological stress and the coping process. New York: McGraw-Hill; 1966.

    Google Scholar 

  49. 49.

    • Kroner-Herwig B, Gassmann J. Headache disorders in children and adolescents: their association with psychological, behavioral, and socio-environmental factors. Headache. 2012;52(9):1387–401. https://doi.org/10.1111/j.1526-4610.2012.02210Cross-sectional study assessing psychosocial variables in primary headache disorders in children and adolescents.

    Article  PubMed  Google Scholar 

  50. 50.

    Russo A, Bruno A, Trojsi F, Tessitore A, Tedeschi G. Lifestyle factors and migraine in childhood. Curr Pain Headache Rep. 2016;20(2):9. https://doi.org/10.1007/s11916-016-0539.

    Article  PubMed  Google Scholar 

  51. 51.

    Waldie KE, Thompson JM, Mia Y, Murphy R, Wall C, Mitchell EA. Risk factors for migraine and tension-type headache in 11-year-old children. J Headache Pain. 2014;15:60. https://doi.org/10.1186/1129-2377-15-60.

    Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Mazzone L, Vitiello B, Incorpora G, Mazzone D. Behavioral and temperamental characteristics of children and adolescents suffering from primary headache. Cephalalgia. 2005;23:206–13. https://doi.org/10.1111/j.1468-2982.2005.01015.

    Article  Google Scholar 

  53. 53.

    Vaillancourt T, Hymel S, McDougall P. Why does being bullied hurt so much? Insights from neuroscience. In: Espelage D, Swearer S, editors. Bullying in North American Schools. New York: Taylor & Francis Group, Inc; 2010. p. 23–33.

    Google Scholar 

  54. 54.

    Knack JM, Jensen-Campbell LA, Baum A. Worse than sticks and stones? Bullying is linked with altered HPA Axis functioning and poorer health. Brain Cogn. 2011;77:183–90. https://doi.org/10.1016/j.bandc.2011.06.011.

    Article  PubMed  Google Scholar 

  55. 55.

    Rudolph KD, Troop-Gordon W, Granger DA. Individual differences in biological stress responses moderate the contribution of early peer victimization to subsequent depressive symptoms. Psychopharmacology. 2011;241:209–19. https://doi.org/10.1007/s00213-010-1879-7.

    CAS  Article  Google Scholar 

  56. 56.

    Ferracini GM, Dach F, Speciali JG. Quality of life and health related disability in children with migraine. Headache. 2014;54:325–34. https://doi.org/10.1007/s11916-016-0539.

    Article  PubMed  Google Scholar 

  57. 57.

    • Randall E, Gray L, Fletcher A. Topical review: perfectionism and pediatric chronic pain: theoretical underpinnings, assessment, and treatment. J Pediatr Psychol. 2018;43(3):326–30. https://doi.org/10.1093/jpepsy/jsx106Topical review examines literature on link between chronic pain and perfectionism and outlines evidence-based assessment and treatment options.

    Article  PubMed  Google Scholar 

  58. 58.

    Luthar SS, Barkin SH. Are affluent youth truly “at risk”? Vulnerability and resilience across three diverse samples. Dev Psychopathol. 2012;24:429–49.

    Article  Google Scholar 

  59. 59.

    Luthar SS, Barkin SH, Crossman EJ. I can, therefore I must: fragility in the upper middle classes. Dev Psychopathol 25th Anniversary Special Issue. 2013;25:1529–49.

    Article  Google Scholar 

  60. 60.

    Luthar SS, Kumar NL. In A. W. Leschied, D. H. Saklofske, and G. L. Flett, Handbook of school-based mental health promotion: an evidence-informed framework. New York: Springer. 2018.

    Google Scholar 

  61. 61.

    •• Randell E, Smith K, Kronmoan C, Conroy C, Smith A, Simmons L. Feeling the pressure to be perfect: Effect on pain-related distress and dysfunction in youth with chronic pain. J Pain. 2018;19(4):418–29. Cross Sectional Study examining perfectionism and various pain conditions among patients with chronic pain conditions at pain rehabilitation center.

  62. 62.

    •• National Academies of Science, Engineering, and Medicine. Vibrant and healthy kids: aligning science, practice, and policy to advance health equity. 2019. Consensus study report on psychological risk factors of students in High Achieving Schools.

    Google Scholar 

  63. 63.

    •• Luthar SS, Kumar N, Zillmer N. High achieving school problems documented, processes implicated, and directions for interventions. Am Psychol. 2019:1–14. https://doi.org/10.1037/amp0000556Public significant statement outlines the literature on psychological risk factors associated with students in High Achieving Schools.

  64. 64.

    Randall ET, Bohnert AM, Travers LV. Understanding affluent adolescent adjustment: the interplay of parental perfectionism, perceived parental pressure, and organized activity involvement. J Adolesc. 2015;41:56–66. https://doi.org/10.1016/j.adolescence.2015.03.005.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Ms. Emily Pierce for her contributions to the literature review for this publication.

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Correspondence to Raquel Langdon.

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This article is part of the Topical Collection on Psychological and Behavioral Aspects of Headache and Pain

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Langdon, R., DiSabella, M., Strelzik, J. et al. Pediatric Migraine and Academics. Curr Pain Headache Rep 24, 40 (2020). https://doi.org/10.1007/s11916-020-00869-5

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Keywords

  • Pediatric migraine
  • Headache
  • School
  • Learning
  • Sleep
  • Perfectionism