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Competing Interests: None declared.

Background and Purpose: Headache is a common health problem in adolescents. There are a number of risk factors for headache in adolescents that are amenable to intervention. The aim of the study was to assess the effectiveness of a low-level headache prevention programme in the classroom setting to prevent these risk factors., Methods: In all, 1674 students in 8th-10th grade at 12 grammar schools in greater Munich, Germany, were cluster randomized into intervention and control groups. A standardized 60-min prevention lesson focusing on preventable risk factors for headache (physical inactivity, coffee consumption, alcohol consumption and smoking) and providing instructions on stress management and neck and shoulder muscle relaxation exercises was given in a classroom setting. Seven months later, students were reassessed. The main outcome parameter was headache cessation. Logistic regression models with random effects for cluster and adjustment for baseline risk factors were calculated., Results: Nine hundred students (intervention group N = 450, control group N = 450) with headache at baseline and complete data for headache and confounders were included in the analysis. Headache cessation was observed in 9.78% of the control group compared with 16.22% in the intervention group (number needed to treat = 16). Accounting for cluster effects and confounders, the probability of headache cessation in the intervention group was 1.77 (95% confidence interval = [1.08; 2.90]) higher than in the control group. The effect was most pronounced in adolescents with tension-type headache: odds ratio = 2.11 (95% confidence interval = [1.15; 3.80])., Conclusion: Our study demonstrates the effectiveness of a one-time, classroom-based headache prevention programme., (© 2014 EAN.)

Background: Tension-type headache and migraine are among the most prevalent chronic disorders in children/adolescents. Data on health care utilization for headache in this age group, however, are sparse., Methods: In 1399 grammar school students (aged 12-19 years) with headache in the last six months in Germany a) the burden of disease for headache (mean intensity, mean frequency in the last three months and PedMIDAS means), b) medical care utilization defined by proportion of students consulting a physician in the last 12 months and/or taking analgetic drugs in the last three months by headache types (migraine and tension-type headache) and by burden of disease were assessed., Results: Primary headache substantially impaired daily living activities in adolescents which was mainly related to migraine. Medical care utilization and drug use, however, was low (consulting a physician: 12.0 %, 95 %-CI = [10.3-13.8]; taking analgetic drugs: 29.9 %, 95 %-CI = [27.5-32.4]) - even among students with severe headache (physician consultation: <35 %; taking analgetic drugs: <63 %). Two thirds of students with any headache and 40 % of those with migraine had neither seen a physician nor used analgetic drugs because of their headache in the preceding 12 months., Conclusions: Adolescents with headache might too rarely seek professional help for treatment of headache. Health promotion in adolescents should increase awareness for evidence-based treatment options for headache.

Background: The identified preventable risk factors for primary headache in adolescents are smoking; consumption of coffee or alcoholic mixed drinks; physical inactivity; muscle pain in the head, neck, or shoulder region; and chronic stress., Objective: To investigate the interrelation of headache with other health complaints and the specificity of the above-mentioned risk factors for headache in adolescents., Methods: A total of 1,260 students (grades 10 and 11) filled in questionnaires on headache, dietary, and lifestyle factors. The type of headache and health complaints such as dizziness, abdominal pain, musculoskeletal pains, symptoms of possible fatigue syndrome, and psychic complaints were assessed., Results: Isolated headache was found in 18% of the headache sufferers; most frequently isolated tension-type headache (78.2%). Only among adolescents with a combination of headache (mainly migraine) and other health complaints, significant associations for almost all analyzed risk factors were found. The strength of the associations with the considered risk factors was very similar in all three analyzed strata except for considerably lower odds ratios for isolated headache., Conclusion: All analyzed risk factors are nonspecific for headache in adolescents because they also increase the risk for other health complaints. Interventions, therefore, should consider a holistic approach focusing not only on headache but also on a broader spectrum of health complaints., (Georg Thieme Verlag KG Stuttgart · New York.)

Although there are few studies on adolescents' beliefs about triggers of headache, none of these compared the associations between perceived and observed triggers. This study aimed at comparing the prevalence of self-perceived and observed risk factors for headache among adolescents. Adolescents from the 10th and 11th grades of high schools answered questionnaires on their headaches and on potential risk factors regarding lifestyle, stress and muscle pain. Individuals reporting to have experienced headache in the preceding 6 months were asked to report what they believed to cause their headache (self-perceived triggers). 1,047 (83 %) of 1,260 adolescents reported headaches. Stress, lack of sleep and too much school work were the most frequently reported self-perceived triggers of headache; in contrast the statistical analysis identified alcohol and coffee consumption, smoking, neck pain, stress and physical inactivity as risk factors for headache. Among individuals with headache, 48 % believed that stress might trigger their headaches, while increased stress scores were only observed in 23 %. In contrast, while 7, 4, 0.3 and 0 % of individuals reporting headache considered consumption of too much alcohol, neck pain, physical inactivity and consumption of coffee might trigger their headache, 56, 51, 36 and 14 %, respectively, were exposed to these risk factors. The prevalence of self-perceived triggers of headache does not correspond to the prevalence of identified risk factors for headaches. While the role of stress was overestimated, the high prevalence of the other confirmed risk factors in adolescents with headache suggests potential for prevention by increasing awareness for these risk factors and appropriate interventions.

Background: The reduction of school years in grammar schools from 9 to 8 years (G9 vs. G8) is supposed to exhibit increased impairments of health of the latter group of students. Aim of the present study was to investigate whether G8-students are exposed to more stress and report more headaches and other health complaints than G9-students., Participants: 1 260 formers of grammar schools in Munich (10 (th) vs. 11 (th) form)., Methods: In a survey, the frequency of headache and other health complaints, experience of chronic stress and health-related quality of life were assessed with a questionnaire and compared between the two groups of different grammar-school durations (G8 vs. G9)., Results: 83.1% of all formers reported to suffer from headache at least once per month. Further frequently reported health complaints were back pain (47.7%), excessive need for sleep (45.6%) and pain in neck or shoulder (45.0%). 20.4% of the formers reported high exposure to stress. The greatest reductions in quality of life were found with respect to school-related and physical wellbeing. As the only significant differences, formers of G8 reported fewer daily leisure time and that available leisure time was not sufficient for recreation., Conclusions: The high prevalence of pain, health complaints and stress indicates high demands to all grammar scholars. High demands due to the reduction of school years in grammar school, however, are not reflected in increased health impairments in these formers, but rather in limited leisure time activities., ((c) Georg Thieme Verlag KG Stuttgart-New York.)

Primary idiopathic headache in childhood can usually be reliably diagnosed on the basis of a comprehensive anamnesis and neurological examination. Wherever necessary, an individualized work-up (including imaging procedures) may be needed to exclude secondary headache. Overall, treatment of headaches is integrative and multimodal, and includes pharmacotherapy, psychological interventional measures, modification. of the daily routine (e.g. drinking, sleeping) and trigger point-based physiotherapy. Fundamental to the treatment of migraine in children is a rapid and appropriate administration of analgesics. In the case of tension headache, the main therapeutic thrust is directed towards adaptation of behavior.

This article, published in the journal Neuropediatrics, explores the association between migraine and muscular hyperalgesia in young adults. The study focuses on the myofascial involvement of neck muscles and uses point-of-care measures like algometry and ultrasound to assess alterations in the upper trapezius muscle (UTM) in migraine patients compared to healthy controls. The results show that migraine patients have a higher frequency and duration of neck pain and lower pressure pain thresholds above the UTM. The study suggests that assessing muscular involvement in headache patients is important for treatment and monitoring. [Extracted from the article]

This article, published in the journal Neuropediatrics, explores the benefits of repetitive neuromuscular magnetic stimulation (rNMS) in pediatric posttraumatic headache (PTH) patients. The study found that rNMS sessions targeting the upper trapezius muscle resulted in a significant decrease in maximum headache intensity and a trend towards lower minimum intensity. Additionally, patients experienced a reduction in hyperalgesia above the trapezius muscle. The authors suggest that rNMS treatment could be a beneficial noninvasive and non-pharmaceutical option for pediatric PTH patients. Further research is needed to confirm these findings. [Extracted from the article]

Introduction A total of 83% of children report headache during a 6-month period. The estimated 1-year prevalence of chronic daily headache (CDH) in children is at least 1 to 2%. Muscle pain is associated with headache severity and chronicity. Muscle pain can be associated with active muscular trigger points, a functional concept still remaining a controversy. An integrated approach including bio-behavioral management is accepted as standard treatment but does not provide sufficient pain relief in all patients. Objective We report the individual clinical course of five adolescents with treatment-refractory CDH associated with focal muscle pain. We describe a concept of short-term integrative intervention including botulinum toxin (StiBo) in a personalized "follow the referred pain pattern" injection regimen with the focus on long-term follow-up. Results StiBo showed short-term efficacy on headache frequency and severity. In the long-term follow-up, CDH was not existent in any of the patients. Conclusion The treatment may have enabled the patients to draw attention away from a repeated circle of muscle-triggered pain and withdrawal of daily activities toward self-driven activities, thereby potentially preventing the development of further chronification. To prove this hypothesis, a prospective, placebo-controlled study in young adolescents with CDH should be initiated including objective outcome parameters on muscular level. [ABSTRACT FROM AUTHOR]

Question To assess clinical and muscular effects of a repetitive neuromuscular magnetic stimulation (rNMS) intervention targeting to the upper trapezius muscles (UTM) in pediatric patients with headache disorders. Methods A retrospective chart review resulted in 23 patients with migraine, migraine + tension-type headache (TTH), or post-traumatic headache (PTH), who received 28 rNMS interventions in a pediatric headache center. During 6 sessions, rNMS was delivered to UTM bilaterally (duration: 15min/side, frequency: 20 Hz, 7s ON-time, 10s OFF-time). Headache frequency, duration, and intensity 3 months before and after treatment were recorded using a customized standardized questionnaire prior to the first treatment and at follow-up (FU). We categorized patients into responder classes based on the relative reduction in headache frequency (≥25%, ≥50%, ≥75%). Effects on the muscular level were assessed by pressure pain thresholds (PPTs) above the UTM before, during rNMS treatment, and at FU after 4 to 20 weeks. Results Data from 20 patients were analyzed (14.10 ± 2.69 years; 60% females) as 2 patients were lost to FU and data of 1 patient was classified as outlier based on a late FU (3 SDs above mean FU time) and excluded from analysis. Compared to baseline, headache frequency (p=.017) and minimum and maximum headache intensities (p=.017; p=.023) were significantly reduced at FU. 11 patients (44%) were classified as ≥25% responders, with 7 patients (28%) experiencing a ≥75% reduction of monthly headache days. PPTs above the UTM significantly increased from baseline (left lateral: 2.00 ± 1.37, left medial: 1.96 ± 1.27, right medial: 1.83 ± 1.26, right lateral: 1.94 ± 1.37) to the last treatment session (left lateral: 3.28 ± 2.21, left medial: 3.17 ± 1.99, right medial: 3.17 ± 2.06, right lateral: 3.24 ± 2.25) (left lateral: p=.002, left medial: p=.002, right medial: p=.001, right lateral: p=.003). This increase from baseline sustains until FU (left lateral: 2.87 ± 2.11, left medial: 2.95 ± 2.11, right medial: 2.95 ± 2.11, right lateral: 2.81 ± 2.04) (left lateral: p=.047, left medial: p=.012, right medial: p=.002, right lateral: p=.028). After 14 rNMS interventions in the primary headache group, 6 patients (43%) were classified as ≥25% responders, with 2 patients (14%) experiencing a ≥75% reduction of monthly headache days. After 11 rNMS interventions in the PTH group, 5 patients (46%) were classified as ≥25% responders, with 5 patients (46%) experiencing a ≥75% reduction of monthly headache days. Conclusion Beneficial effects regarding headache characteristics and muscular PPTs were documented in pediatric patients with headache disorders. The latter having a sustained effect up to weeks to months. Based on the concept of the trigemino-cervical complex, rNMS of the UTM may act via neuromodulation of nociceptive processing at the central level. [ABSTRACT FROM AUTHOR]

Question To assess the safety of and satisfaction with a repetitive neuromuscular magnet stimulation (NMS) intervention targeting to the upper trapezius muscles (UTM) in pediatric patients with headache disorders. Methods Retrospective chart review including 33 patients with migraine, tension-type headache, or post-traumatic headache, who had received at least one test rNMS session targeting to UTM. In patients choosing to undergo rNMS intervention, adherence rate was calculated based on the number of completed rNMS sessions. For patients undergoing the rNMS intervention, safety of and satisfaction with the intervention were assessed by customized questionnaires. Results 33 patients (13.94 ± 2.51 years; 61% females) received at least a test rNMS session to become acquainted with the stimulation setting, resulting in 182 rNMS sessions. In 142 sessions (78%) no adverse events were reported. 43 adverse events were documented for 40 sessions (22%). Related side effects during stimulation included tingling (32.6%), shoulder pain (9.3%), back pain (9.3%), feeling of heaviness (4.7%), trembling (2.3%), and unpleasant tension (2.3%). Related side effects in-between interventions included muscle sore (25.5%), headache (4.7%), and a short-lasting muscle cramp in the upper arm (2.3%). Adverse events categorized unlikely related to the intervention were described in 3 sessions by 2 patients and included shoulder pain (4.7%) and an electrifying feeling radiating to the right hip (2.3%). In these 33 patients, 6 patients (18%) did not continue after the test rNMS session and 4 patients (12%) who started the intervention did not complete the full treatment. 23 patients (70%) completed 28 rNMS interventions with at least 5 of 6 sessions. At follow-up (FU) of 24 interventions, patients completed the customized satisfaction questionnaire. After 13 interventions (54.2%), the treatment was rated as "the therapy helped very well", after 5 interventions (20.8%) as "the therapy helped well", after 1 intervention (4.2%) as "indecisive", after 3 interventions as "the therapy rather did not help", and after 2 interventions as "the therapy did not help". At FU of 25 interventions, patients completed the customized questionnaire regarding repetition of the treatment. After 23 interventions (88.5%), patients would repeat the treatment. At FU of 19 interventions, patients completed the questionnaire regarding recommendation of treatment. After 18 interventions (96.2%), patients would recommend rNMS to other affected patients. Conclusion Stimulation by rNMS was found to be a feasible, safe, and well-accepted treatment option for children and adolescents with headache disorders. Thus, rNMS of the UTM may become a valuable non-invasive, non-pharmacological treatment option for pediatric headache disorders. [ABSTRACT FROM AUTHOR]