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Source: Waldie KE. Childhood headache, stress in adolescence, and primary headache in young adulthood: A longitudinal Cohort Study. Headache. 2001;41:1-10.
The causal relation between stress and headache has not been adequately determined. Stressful life events can be risk factors for pain as well as consequences of pain. For example, it is not known whether frequent headaches in childhood influence the appraisal of life events or if prolonged stress affects future headache status of both. Previous attempts to study this issue have been fraught with methodological problems ranging from selection bias, to small sampling sizes, to a lack of standardized headache criteria.
Waldie reports on the results of a longitudinal study of 481 women and 499 men enrolled in the Dunedin Multidisciplinary Health and Development Study. This is a longitudinal study project looking at health and behavior of a birth cohort of children born in Dunedin, New Zealand, from April 1, 1972 to March 31, 1973. In this particular arm of the study headache frequency at ages 7, 9, and 11 was recorded. A total of 305 or 35.9% of children reported more than 1 headache per month and were defined as having a positive headache history.
At age 15 a stress assessment was obtained according to a 21-item "Feel Bad" scale listing items that could potentially cause stress in adolescents. Each item was then scored accordingly as producing "mild," "moderate," or "severe" stress. In the group with a positive headache history there was a 1.5 times more likelihood of reported stress at age 15 compared to children without a headache history before age 12.
At age 26 the cohort was evaluated to determine an IHS classifiable headache disorder. Of the 980 patients who were sampled at age 26, 72 (7.3%) fulfilled HIS criteria for migraine headache (MH), 109 (11.1%) for tension-type headache (TTH), and 42 (4.3%) for combined MH and TTH. In order to test the relationship between stress at age 15 and headache diagnosis at age 26, a multivariate analysis of variance was performed on mild, moderate, and high stress data. At age 26 study members who reported high stress at age 15 were 2.6 times more likely to be diagnosed with migraine than those who were not. This group was twice as likely to have a combined headache disorder. Unexpectedly, study members with TTH were not found to experience increased stress during adolescence. Only when individual stressors were examined did a weak association emerge between the stress of changing bodily image in adolescence and the development of TTH later in life.
Waldie concludes that head pain in childhood may be a risk factor for experiencing high levels of stress in mid adolescence. In addition, stress in adolescence may contribute to the development of headache in young adulthood. From the current study it is not possible to determine a more specific cause and effect.
Several points can be made with regards to the findings of this study. First is the recognition that childhood headache can predispose children to the experience of stress later in life. Headache in this age group is notoriously under diagnosed and under treated and these findings should make proper headache diagnosis and treatment a more urgent matter. Second, the lack of association between adolescent stress and later development of TTH is notable and argues for a more fundamental physiological understanding of TTH. Waldie concludes that perhaps more recent stressors are important in the development of TTH but that still remains to be determined. And finally, a problem with this study, as with a lot of studies examining the role of "stress," is that they do not take into account the subjective nature of "stress." What is "stressful" for one individual may be exhilarating for another. Personality profiles and affective mood scores maybe be a helpful third variable to better discern the role stress plays in a person’s life and subsequently, in any medical condition, not just headache. —Jeffrey B. Reich