LOS ANGELES – Three-fourths of 82 adolescent girls with chronic daily headache also fulfilled diagnostic criteria for fibromyalgia, and other pain-related disorders and comorbidities were common in a screening study.
Although adults with chronic daily headache are known to be at higher risk for pain in other body regions, compared with adults without chronic daily headache, it has not been known whether this phenomenon also applies to adolescents, or to what extent.
Dr. Daniel J. Lacey screened for “central sensitization” pain comorbidities in adolescent girls with chronic daily headache seen in the chronic pain or adolescent headache clinics at a Midwestern children's hospital. He also screened for more commonly recognized comorbidities – anxiety, depression, and sleep disorders – in children with chronic headache, as well as for neck and back pain, orthostatic intolerance, dysmenorrhea, pelvic pain, and joint pain or swelling.
In all, 62 patients (75%) had more than five positive fibromyalgia syndrome tender points, although only 25 of these patients complained of chronic widespread pain (40% of screen-positive patients), he reported in a poster presentation at the meeting In addition, 49 patients (60%) screened positive for irritable bowel disease, and 37 patients (45%) reported at least moderate neck and/or back pain. Most patients complained of significant chronic tiredness, and 12 (15%) screened positive for chronic fatigue syndrome, reported Dr. Lacey of Wright State University in Dayton, Ohio.
Almost the entire cohort had mild orthostatic intolerance, and 16 patients (19%) felt that it was disruptive. Five patients (6%) had postural orthostatic tachycardia syndrome. Although 19 patients (23%) said that anxiety and/or depression were significant issues, mothers of the patients rated these two problems as much more consequential, he said.
Nearly all patients complained of at least moderate levels of nonrestorative sleep. Dysmenorrhea was common. School absences were a significant problem for 25 patients (30%), and many others were being homeschooled or were pursuing online education.
“Clinicians who treat teens with chronic daily headache also need to screen for other pain disorders in addition to other pain comorbidities,” Dr. Lacey stated in the poster. “Those adolescents who have chronic daily headache and irritable bowel syndrome are at highest risk for central sensitization disorders such as fibromyalgia syndrome, chronic fatigue, and disturbed sleep. If these are not recognized and adequately treated, restoration of normal functioning may be limited.”
Cognitive problems were only infrequently seen in this cohort.
Chronic daily headache was the initial manifestation of headache disorder in 19 patients (23%). Most patients had episodic, intense migraines in addition to their usually migrainous chronic daily headache.
Because of the small number of patients and the multiple and different medications being used by patients, Dr. Lacey could not rigorously compare the efficacies of treatments for chronic daily headache in patients with or without pain comorbidities. His experience suggests, however, that medications used primarily for headaches may not be as effective for adolescents who also have comorbid pain disorders.
When amitriptyline monotherapy was used to treat chronic daily headache, the headaches improved similarly in patients with or without other pain comorbidities. When topiramate or valproate monotherapy was used, however, these agents seemed to be less successful at improving headaches in patients with other pain comorbidities, compared with patients who had chronic daily headache alone, said Dr. Lacey, who indicated that he had no conflicts of interest.