Headache, mood disorders increase among pediatric patients during COVID-19 pandemic

Source/Revelations

Source:

Pierce E, et al. Pediatric headache experience during the COVID-19 pandemic. Presented at: American Headache Society Annual Scientific Meeting; June 3-6, 2021 (virtual meeting).

disclosures:
DiSabella does not report any relevant financial disclosures.

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Pediatric patients with headache experienced increased headache frequency, worse anxiety and mood, less physical activity and more screen time during the COVID-19 pandemic, despite reported improvements in hydration, sleep and diet.

The researchers from Children’s National Health System in Washington, DC, presented their findings from a patient-reported questionnaire at the American Headache Society Virtual Annual Scientific Meeting.

Reference: Pierce E, et al. Pediatric headache experience during the COVID-19 pandemic. Presented at: American Headache Society Annual Scientific Meeting; June 3-6, 2021 (virtual meeting).

“Childhood headaches are very common. If you add up all the asthma and diabetes in the United States, that equals the number of patients with migraines. It’s a huge, huge public health problem,” Marc DiSabella, DO, director of the headache and pediatric neurology fellowship program and medical director of neurology education at Children’s National, told Healio Neurology. The morbidity associated with pediatric headaches is four times that of a pediatric brain tumor diagnosis. That’s how strong it plays a role in your life because you just don’t know what’s going to happen.”

DiSabella and colleagues began to see trends in their pediatric headache patients during the COVID-19 pandemic, including children who did better and did worse. In the current study, they wanted to find out the reasons for these changes.

“Much of the headache care is about lifestyle adjustments, including hydration, exercise, sleep and diet goals and how to use screens properly,” he continued. “All these things have changed during the pandemic.”

Lifestyle Impact

The researchers examined children seen in the Children’s National Hospital headache clinic between summer 2020 and winter 2021. Patients completed a questionnaire that looked at changes in headache characteristics and lifestyle factors since the start of the pandemic.

The study included 113 pediatric patients with headaches. The study population included more girls than boys (60% vs. 40%) and more than half of the children were 12 to 17 years old (63%). The most common diagnoses were chronic migraine (37%), migraine with aura (22%), migraine without aura (19%), and new daily persistent headache (15%).

DiSabella and colleagues found that the percentage of patients reporting the same amount or more physical activity (46%) was comparable to the percentage of patients reporting less physical activity (54%) since the start of the pandemic. Most children (79%) reported eating the same amount or more since the start of the pandemic, while a smaller percentage (21%) reported eating less. A similar percentage of children (84%) reported drinking the same amount or more fluids since the start of the pandemic, compared to those who reported reduced fluid intake (16%). Most children (78%) also reported getting the same or better quality of sleep, compared with 22% of children who reported less sleep since the start of the pandemic.

“Most patients, at least according to reports, said they drank better, slept better and ate better, but exercised less. That wasn’t too surprising to us, but of the sleep, hydration, exercise and diet goals, aerobic activity is probably the one with the best evidence for its effectiveness,” DiSabella said. “That was important to recognize because when we look at why these kids have progressively worse headaches, if there’s anything we’re going to look at more closely, it’s probably going to be physical activity.”

Changes in headache type, mood

The researchers also looked at changes in headache type and mood over the course of the pandemic, as well as screen time. DiSabella and colleagues found that episodic headaches decreased from 70% before the pandemic to 51% since the start of the pandemic, while chronic or daily headache disorders increased from 30% to 49% and constant daily headaches increased from 20% to 32%. According to the survey results, nearly half of all patients (46%) said their headaches had worsened since the start of the pandemic. About half of the patients reported worse anxiety (55%) and mood (48%), and felt more stressed (55%). A small percentage (12%) said they felt less stressed, the researchers noted. In addition, just over half of patients (55%) reported that their school workload was the same or better since the start of the pandemic. More than half of respondents (62%) said using screen time made their headaches worse.

“There’s a headache disorder called new daily persistent headache where people have headaches every day, all the time. It’s the most resistant condition to any kind of management,” DiSabella said. “In our population, we almost doubled in new daily persistent headaches. That’s a big, big number.”

He also noted that “many factors” affected pediatric patients with headaches during the pandemic.

“Despite patients following most lifestyle recommendations, with the exception of exercise, which we recommend for headaches, they still had worsening headaches and anxiety. It may be that the benefits of changing our lifestyle and all the things we thought were really important don’t outweigh the benefits of being social and being around other kids,” DiSabella said. “Many children were afraid of what would happen to them or their family or their grandparents, and fear fueled even more of our fear. We were also taken away from our social circles, where we got a lot of our reassurance in life.”

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