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Systematic Review of Childhood and Adolescent Risk and Prognostic Factors for Recurrent Headaches

  • Anna Huguet
    Correspondence
    Address reprint requests to Anna Huguet, PhD, Centre for Research in Family Health, Room K8531 8th Floor Children's Building, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS B3K 6R8, Canada.
    Affiliations
    Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada

    IWK Health Centre, Halifax, Nova Scotia, Canada
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  • Michelle E. Tougas
    Affiliations
    IWK Health Centre, Halifax, Nova Scotia, Canada

    Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Jill Hayden
    Affiliations
    Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Patrick J. McGrath
    Affiliations
    Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada

    IWK Health Centre, Halifax, Nova Scotia, Canada

    Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada

    Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada

    Department of Faculty of Science, Dalhousie University, Halifax, Nova Scotia, Canada

    Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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  • Christine T. Chambers
    Affiliations
    IWK Health Centre, Halifax, Nova Scotia, Canada

    Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada

    Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Jennifer N. Stinson
    Affiliations
    Child Health Evaluative Sciences, Chronic Pain Program, The Hospital for Sick Children, Toronto, Ontario, Canada

    Chronic Pain Program, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Lori Wozney
    Affiliations
    IWK Health Centre, Halifax, Nova Scotia, Canada
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      Highlights

      • The literature regarding risk and prognostic factors for headaches was reviewed.
      • There is still limited knowledge and poor quality of evidence.
      • Female sex is a probable risk factor for onset of headaches.
      • Comorbid anxiety/depression is a probable prognostic factor for persistence of headaches.
      • Further research is needed.

      Abstract

      Little is known about childhood and adolescent risk and prognostic factors for recurrent headaches. This systematic review 1) examined longitudinal evidence about factors associated with onset and course of recurrent headaches in childhood or adolescence, using meta-analysis where possible, and 2) evaluated the quality of this evidence using a modified Grading of Recommendations Assessment, Development and Evaluation framework. Through searching electronic databases, reference lists of included studies, and an electronic mail list we identified and included 23 articles reporting 19 cohorts. From the included studies we explored 27 risk factors for recurrent headaches, 27 prognostic factors for persistence of recurrent headaches, and 6 prognostic factors for presence of headache-related disability. The quality of evidence for most associations is low or very low. There is moderate-quality evidence that women are at risk of developing recurrent headaches and of headaches persisting. There is high-quality evidence suggesting that children with negative emotional states manifested through anxiety, depression, or mental distress are not at risk of developing headache, but moderate-quality evidence suggests that the presence of comorbid negative emotional states in children with headaches is associated with increased risk of headache persistence. Because of the small number of studies, further investigation is needed to increase confidence in existing evidence and to explore new risk and prognostic factors.

      Perspective

      This is a review of the evidence about childhood and adolescent risk and prognostic factors for the onset of recurrent headaches and their course. Understanding these factors can help identify childrens' risk and may suggest ways to reduce this risk.

      Key words

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