Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Headache. 2023 Jul-Aug;63(7):942-952. doi: 10.1111/head.14525. Epub 2023 Jun 14.
Youth with continuous (always present) headache are vastly understudied; much remains to be understood regarding treatment response in this population.
To describe and explore biopsychosocial factors related to initial clinical outcomes among treatment-seeking youth with continuous headache.
This retrospective cohort study extracted data of 782 pediatric patients (i.e., aged <18 years) with continuous headache from a large clinical repository. Youth in this study had experienced continuous headache for ≥1 month before presenting to a multidisciplinary headache specialty clinic appointment. Extracted data from this appointment included patients' headache history, clinical diagnoses, and headache-related disability, as well as information about biopsychosocial factors implicated in headache management and/or maintenance (e.g., healthy lifestyle habits, history of feeling anxious or depressed). Additional data regarding patient headache characteristics, disability, and lifestyle habits were extracted from a subset of 529 youth who returned to clinic 4-16 weeks after their initial follow-up visit. After characterizing initial treatment response, exploratory analyses compared youth with the best and worst treatment outcomes on several potentially influential factors.
Approximately half of youth (280/526; 53.2%) continued to have continuous headache at follow-up, ~20% of youth (51/526) reported a significant (≥50%) reduction in headache frequency. Improvements in average headache severity (e.g., percentage with severe headaches at initial visit: 45.3% [354/771]; percentage with severe headaches at follow-up visit: 29.8% [156/524]) and headache-related disability were also observed (e.g., percentage severe disability at initial visit: 62.9% [490/779]; percentage severe disability at initial follow-up visit: 34.2% [181/529]). Individuals with the worst headache frequency and disability had a longer history of continuous headache (mean difference estimate = 5.76, p = 0.013) and worse initial disability than the best responders (χ [3, 264] = 23.49, p < 0.001). They were also more likely to have new daily persistent headache (χ [2, 264] = 12.61, p = 0.002), and were more likely to endorse feeling depressed (χ [1, 260] = 11.46, p < 0.001).
A notable percentage of youth with continuous headache show initial improvements in headache status. Prospective, longitudinal research is needed to rigorously examine factors associated with continuous headache treatment response.
持续性（始终存在）头痛的青少年患者研究甚少；对于这一人群的治疗反应，仍有许多未解之谜。
描述和探讨与寻求治疗的持续性头痛青少年的初始临床结果相关的生物心理社会因素。
本回顾性队列研究从一个大型临床数据库中提取了 782 名患有持续性头痛的儿科患者（即年龄<18 岁）的数据。该研究中的青少年在出现于多学科头痛专科诊所就诊前，已经经历了至少 1 个月的持续性头痛。本次就诊提取的数据包括患者的头痛病史、临床诊断以及与头痛相关的残疾情况，以及与头痛管理和/或维持相关的生物心理社会因素信息（例如，健康的生活习惯、焦虑或抑郁的既往史）。另外，还从最初随访后 4-16 周回到诊所的 529 名青少年中提取了患者头痛特征、残疾和生活习惯方面的额外数据。在对初始治疗反应进行描述后，探索性分析比较了治疗效果最好和最差的青少年在几个潜在影响因素上的差异。
大约一半的青少年（280/526；53.2%）在随访时仍有持续性头痛，约 20%的青少年（51/526）报告头痛频率显著（≥50%）降低。头痛严重程度的平均改善（例如，初诊时严重头痛的比例：45.3%[354/771]；随访时严重头痛的比例：29.8%[156/524]）和与头痛相关的残疾情况也有所改善（例如，初诊时严重残疾的比例：62.9%[490/779]；最初随访时严重残疾的比例：34.2%[181/529]）。头痛频率和残疾最严重的患者头痛持续时间更长（平均差异估计值=5.76，p=0.013），且初始残疾程度比最佳反应者更差（χ[3, 264]=23.49，p<0.001）。他们也更有可能患有新发每日持续性头痛（χ[2, 264]=12.61，p=0.002），且更有可能感到抑郁（χ[1, 260]=11.46，p<0.001）。
有相当比例的持续性头痛青少年患者的头痛状况在初始治疗后有所改善。需要进行前瞻性、纵向研究来严格检查与持续性头痛治疗反应相关的因素。
