Abstract
Many children experience chronic headaches, particularly migraine and tension headaches. These can be quite debilitating for the child and produce much concern from caregivers and health professionals. Following a discussion of pathophysiology and epidemiological findings, we emphasize the need for nonpharmacological interventions for chronic headaches. This review explores advances in the behavioral assessment and treatment of childhood headaches. We outline behavioral assessment procedures, including the behavioral interview, headache questionnaires, self-monitoring, caregiver observations, and psychophysiological recording. Treatment typically encompasses relaxation training, biofeedback, assertion training, and cognitive therapy. Parental involvement is also one emphasized component in behavioral approaches to treatment. Our review suggests that behavioral treatment strategies are effective in the management of childhood headaches, although most of the research support appears limited to relaxation training and biofeedback. Nonetheless, behavioral assessment and treatment of childhood headaches appears to be a promising clinical and research direction.
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Andrasik, F., Blanchard, E. B., Edlund, S. R., and Attanassio, V. (1983). EMG biofeedback treatment for a child with muscle contraction headache.Am. J. Clin. Biofeed. 6: 96–102.
Andrasik, F., Burke, E. J., Attanassio, V., and Rosenblum, E. L. (1985). Child, parent and physician reports of a child’s headache pain: Relationship prior to and following treatment.Headache 22: 421–425.
Bakal, D. A. (1982).The Psychobiology of Chronic Headache, Springer, New York.
Beames, L., Sanders, M. R., and Bor, W. (1992). The role of parent training in the cognitive-behavioral treatment of children’s headaches.Behav. Psychother. 20: 167–180.
Bille, B. (1962). Migraine in school children.Acta Paediatr. Scand. 51 (Suppl 136), 1–151.
Bille, B. (1981). Migraine in childhood and its prognosis.Cephalalgia 1: 71–75.
Blanchard, E. B., and Andrasik, F. (1985).Management of Chronic Headaches. A Psychological Approach. Pergamon Press, New York.
Blanchard, E. B., Andrasik, F., and Arena, J. G. (1984). Personality and chronic headache. In Maher, B. A. (ed.),Progress in Experimental Personality Research, Vol.13, Academic Press, New York.
Budd, K. S., and Kedesdy, J. H. (1989). Investigation of environmental factors in pediatric headaches.Headache 29: 569–573.
Budd, K. S., Workman, D. E., Lemsky, C. M., and Quick, D. M. (1994). The Children’s Headache Assessment Scale (CHAS): Factor structure and psychometric properties.J. Behav. Med. 17: 159–179.
Burke, E. C., and Peters, G. A. (1956). Migraine in childhood.Am. J. Disabled Children 92: 330–336.
Carlsson, J., Larsson, B., and Marks, A. (1996). Psychosocial functioning in school children with recurrent headaches.Headache 36: 77–82.
Carolei, C.M., Marini, C., and De Matteis, G. (1996). History of migraine and risk of cerebral ischaemia in young adults.Lancet 347: 1503–1506.
Cinciripini, P.M., Williamson, D.A., and Epstein, E.H. (1980). Behavioral treatment of migraine headaches. In Ferguson, J. M., and Taylor, C. B. (eds.),The Comprehensive Handbook of BehavioralMedicine, Vol. 2, Jamaica, NY, Spectrum Press, pp. 207–227.
Collin, C., Hockaday, J. M., and Waters, A. E. (1985). Headache and school absence.Arch. Dis. Child. 60: 245–247.
Cooper, P. J., Bawden, H. N., Camfield, P. R., and Camfield, C. S. (1987). Anxiety and life events in childhood migraine.Paediatrics 79: 999–1004.
Dalessio, D.J. (1972).Wolff’s Headache and Other Head Pain, Oxford University Press, New York.
Deubner, D.C. (1977). An epidemiological study of migraine and headache in 10–20 year olds.Headache 17: 173–180.
Duckro, P.-N., and Cantwell-Simmons, E. (1989). A review of studies evaluating biofeedback and relaxation training in the management of pediatric headache.Headache 29: 428–433.
Engel, J. M., Rapoff, M. A., and Pressman, A.R. (1992). Long-term followup of relaxation training for pediatric headache disorders.Headache 32: 152–156.
Fentress, D.W., Masek, B.J., Mehegan, J.E., and Benson, H. (1986). Biofeedback and relaxation response training in the treatment of pediatric migraine.Dev. Med. Child Neurol. 28: 139–146.
Forehand, R. L., and McMahon, R. J. (1981).Helping the Noncompliant Child. A Clinician’s Guide to Parent Training, Guilford Press, New York.
Gannon, I. R., Haynes, S. N., Cucvas, J., and Chavez, R. (1987). Psychophysiological correlates of induced headaches.J. Behav. Med. 10: 411–423.
Glaser, J. (1954). Migraine in paediatric practice.Am. J. Disabled Children 88: 92–98.
Grazzi, L., Leone, F., Frediani, F., and Busone, G. (1990). A therapeutic alternative for tension headache in children: Treatment and 1-year follow-up results.Biofeed. Self-Regul. 15: 1–6.
Guarnieri, P., and Blanchard, E. B. (1990). Evaluation of home-based thermal biofeedback treatment of pediatric migraine headache.Biofeed. Self-Regul. 15: 179–184.
Headache Classification Committee of the International Headache Society (1988). Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain.Cephalalgia 8 (Suppl. 7): 1–96.
Hoelscher, T. J., and Lichstein, K. L. (1983). Behavioral assessment and treatment of child migraine: Implications for clinical research and practice.Headache 24: 94–103.
Holroyd, K. A., and Andrasik, F. (1978). Coping and control of chronic tension headache.J. Consult. Clin. Psychol. 46: 1036–1045.
Kearney, B. G., Wilson, P., and Haralambous, G. (1987). Stress appraisal and personality characteristics of headache patients. Comparisons with tinnitus and normal control groups.Behav. Change 4: 25–32.
Kim, M., and Blanchard, E. B. (1992). Two studies of the non-pharmacological treatment of menstrually-related migraine headaches.Headaches 32: 197–202.
King, N. J., and Remenyi, A. (eds) (1986).Health Care: A Behavioural Approach. Grune and Stratton, Sydney.
King, N. J., and Sharpley, C. F. (1990). Headache activity in children and adolescents.J. Paediatr. Child Health 26: 50–54.
King, N. J., Ollendick, T. H., and Tonge, B. J. (1995).School Refusal: Assessment and Treatment. Allyn and Bacon, Boston.
Labbé, E. E. (1995). Treatment of childhood migraine with autogenic training and skin temperature biofeedback: A component analysis.Headache 35: 10–13.
Labbé, E. E., and Ward, C. H. (1990). Electromyographic biofeedback with mental imagery and home practice in treatment of children with muscle-contraction headaches.Dev. Behav. Pediat. 11: 65–68.
Labbé, E. L., and Williamson, D. A. (1984). Treatment of childhood migraine using autogenic feedback training.J. Consult. Clin. Psychol. 52: 968–976.
Labbé, E. E., Williamson, D. A., and Southard, D. R. (1985). Reliability and validity of children’s reports of migraine headache symptoms.J. Psychopathol. Behav. Assess. 7: 375–383.
Lake, A. E. (1980). Behavioral assessment considerations in the management of headache.Headache 21: 170–178.
Larsson, B., and Melin, L. (1986). Treatment in a school-setting with relaxation training as compared with information-contact and self-registration.Pain 25: 325–336.
Larsson, B., Daleflod, B., Håkansson, L., and Melin, L. (1987a). Therapist-assisted versus self-help relaxation treatment of chronic headaches in adolescents: A school-based intervention.J. Child Psychol. Psychiatry 28: 127–136.
Larsson, B., Melin, L., Lamminen, M., and Ullstedt, F. (1987b). School-based treatment of chronic headaches in adolescents.J. Pediatr. Psychol. 12: 553–566.
Larsson, B., Melin, L., and Döberl, A. (1990). Recurrent tension headache in adolescents treated with self-help, relaxation training and a muscle relaxant drug.Headache 30: 665–671.
Lascelles, M. A., McGrath, P. J., Sullivan, M. J. L., and Werk, A. (1991). Self-administered treatments for adolescents with headache: Description, applications and limitations.Headache Q. Curr. Treat. Res. 2: 196–200.
Lewis, D. W., Middlebrook, M. T., Mehallick, L., Ranch, T. M., Deline, C., and Thomas, E. F. (1996). Pediatric headaches: What do the children want?Headache 36: 224–230.
Linet, M. S., Stewart, W. F., Celentano, D. D., Ziegler, D., and Sprecher, M. (1989). An epidemiologic study of headache among adolescents and young adults.JAMA 261: 2211–2216.
Marrazo, M. J., Hickling, E. J., and Sison, G. F. P. (1984). The combined use of rational-emotive therapy and biofeedback in the treatment of childhood migraine.J. Ration. Emot. Ther. 2: 27–31.
Martin, P. (1993).Psychological Management of Chronic Headaches. Guilford Press, New York.
Martin, P. R., and Mathews, A. M. (1978). Tension headaches. Psychophysiological investigation and treatment.J. Psychosom. Res. 22: 389–399.
Martin, P. R., Marie, G. V., and Nathan, P. R. (1992). Psychophysiological mechanisms of chronic headaches: Investigation using pain induction and pain reduction procedures.J. Psychosom. Res. 36: 132–148.
Matson, J. L., and Ollendick, T. H., (1988).Enhancing Children’s Social Skills, Pergamon Press, Elmsford, NY.
McGrath, P. J., Humphreys, P., Goodman, J. T., Keene, D., Firestone, P., Jacob, P., and Cunningham, S. J. (1988). Relaxation prophylaxis for childhood migraine: A randomized placebo-controlled trial.Dev. Med. Child Neurol. 30: 626–631.
McGrath, P. J., Humphreys, P., Keene, D., Goodman, J. T., Lascelles, M. A., Cunningham, S. J., and Firestone, P. (1992). The efficacy and efficiency of a self-administered treatment for adolescent migraine.Pain 49: 321–324.
Meichenbaum, D. A. (1975). A self-instructional approach to stress-management: a proposal for stress inoculation training. In Sarason, I., and Spielberger, C. D. (eds.),Stress and Anxiety, Vol. 1, Wiley, New York.
Mindell, J. A., and Andrasik, F. (1987). Headache classification and factor analysis with a pediatric population.Headache 27: 96–101.
O’Brien, M. D. (1971). Cerebral blood changes in migraine.Headache 10: 139–143.
Ollendick, T. H., and Hersen, M. (eds.) (1984).Child Behavioral Assessment. Principles and Procedures. Pergamon Press, New York.
Ollendick, T. H., and Hersen, M. (eds.) (1993).Handbook of Child and Adolescent Assessment. Allyn and Bacon, Boston.
Olness, K., MacDonald, J. T., and Uden, D. L. (1987). Comparison of self-hypnosis and propranolol in the treatment of juvenile classic migraine.Pediatrics 79: 593–597.
Ostfeld, A. M., and Wolff, H. G. (1958). Identification, mechanisms and management of the migraine syndrome.Med. Clin. North Am. 42: 1497–1509.
Payne, B., and Norfleet, M.A. (1986). Chronic pain and the family.Pain 26: 1–22.
Prensky, A., and Sommer, D. (1979). Diagnosis and treatment of migraine in children.Neurology 29: 506–510.
Pritchard, D. (1995). EMG levels in children who suffer from severe headaches.Headache 35: 554–556.
Richter, J. C., McGrath, P. J., Humphreys, P. J., Goodman, J. T., Firestone, P., and Keene, D. (1986). Cognitive and relaxation treatment of pediatric migraine.Pain 25: 195–203.
Robin, A. L., and Foster, S. (1989).Negotiating Parent-Adolescent Conflict. Guilford Press, New York:
Rosen, J. A. (1982). Observations on the efficacy of propranolol for the prophylaxis of migraineAnn. Neurol. 13: 92–93.
Rozensky, R. H., and Pasternak, J. F. (1985). Obi-Wan Kenobi, “The Force,” and the art of biofeedback: A headache treatment for overachieving boys.Clin. Biofeed. Health 8: 9–13.
Sanders, M., and Dadds, M. (1993).Behavioral Family Intervention. Allyn and Bacon, Boston.
Schoenen, J., Jamart, B., Gerard, P., Lenarduzzi, P., and Delwaide, P. J. (1987). Exteroceptive suppression of temporalis muscle activity in chronic headache.Neurology 37: 1834–1836.
Schultz, J. H., and Luthe, V. (1969).Autogenic Training, Vol. 1, Grune and Stratton, New York.
Scott, M., Womack, W. M., and Chen, A. C. N. (1991). Anxiety and depression in the behavioral treatment of headache in children and adolescents.Int. J. Adolesc. Med. Health 5: 17–35.
Sillanpaa, M. (1983a). Changes in the prevalence of migraine, and other headaches during the first seven school years.Headache 23: 15–29.
Sillanpaa, M. (1983b). Prevalence of headache in prepuberty.Headache 21: 10–14.
Smith, M. S., Womack, W. M., and Chen, A. C. W. (1990). Intrinsic patient variables and outcomes in the behavioral treatment of recurrent pediatric headache. In Tyler, D. C., and Krane, E. J. (eds.),Advances in Pain Research Therapy, Vol. 15, Raven Press, New York.
Sparks, J. P. (1978). The incidence of migraine in school children.Practitioner 221: 407–411.
Trued, S. (1974). Migraines in childhood.J. Am. Med. Women’s Assoc. 29: 78–86.
Tunis, M. M., and Wolff, H. G. (1953). Studies on headache: Long-term observations of the reactivity of the cranial arteries in subjects with vascular headache of the migraine type.Arch. Neurol. Psychiatry 70: 551–557.
Waranch, H. R., and Keenan, D. M. (1985). Behavioral treatment of children with recurrent headaches.J. Behav. Ther. Exp. Psychiatry 16: 31–38.
Williamson, D. A., Baker, J. D., and Cubic, B. A. (1993). Advanced in pediatric headache research. In Ollendick, T. H., and Prinz, R. J. (eds.),Advances in Clinical Child Psychology, Vol. 15, Plenum Press, New York.
Wisniewski, J. J., Genshaft, J. C., Mulick, J. A., Coury, D. J., and Hammer, P. (1988). Relaxation therapy and compliance in the treatment of adolescent headache.Headache 28: 612–617.
Wolff, H. G. (1963).Headache and Other Pain. Oxford University Press, London.