Behaviour during attacks and assessment of intensity in primary headaches of children and adolescents
L N Rossi1, I Cortinovis, L Menegazzo
12nd Paediatric Department, University of Milan, Milan, Italy. livia.rossi@unimi.it
Insights
Assessing children's behavior during primary headache attacks can indirectly measure pain intensity and disability. This approach offers valuable insights, even with some limitations, for understanding pediatric headache experiences.
Area of Science:
- Pediatric Neurology
- Headache Medicine
- Clinical Psychology
Background:
- Limited research exists on assessing primary headache attack intensity in children.
- International classifications lack specific criteria for defining pediatric headache pain intensity.
- Understanding attack intensity is crucial for effective management and treatment of pediatric headaches.
Purpose of the Study:
- To evaluate if child or parent-reported behavior during attacks can serve as a measure of attack disability.
- To determine the utility of behavioral observation as an indirect indicator of attack intensity in pediatric primary headaches.
- To identify distinct behavioral patterns associated with varying levels of headache disability in children and adolescents.
Main Methods:
- A cohort of 320 pediatric patients (3-14 years) with primary recurrent headaches was studied.
- Twelve historical variables were analyzed using multiple correspondence analysis and cluster analysis.
- Five distinct behavioral types during headache attacks were identified and categorized.
Main Results:
- Five behavioral patterns ranged from no limitation to requiring rest in darkness during attacks.
- Child's behavior during attacks provided information independent of age.
- Maternal educational level was identified as a factor influencing behavioral reporting, indicating a limitation.
Conclusions:
- Child and parent-reported behaviors during primary headache attacks offer valuable indirect measures of attack intensity and disability.
- Behavioral assessment, combined with pain scores, can enhance the understanding of pediatric headache severity.
- Further research is needed to refine behavioral assessment tools and address identified limitations in pediatric headache management.
Abstract:
Assessment of attack intensity in primary headaches of paediatric age has not received great attention in the literature to date and in the international classification the criteria to define pain intensity are also not specified. The purpose of this research was to evaluate whether behaviour during attacks, reported by the child or a parent, can be used as a measure of attack disability, and so as an indirect measure of attack intensity in primary headaches of children and adolescents. The subjects were 320 patients aged between 3 and 14 years (mean age 9.9 years, SD 2.6 years) affected by primary recurrent headaches and first seen at a headache clinic. Twelve variables taken from their history were considered and sequentially analysed with multiple correspondence analysis and cluster analysis. Five types of behaviour during attacks were identified: (i) the child (or the parent) is unable to answer the questions or the child has no limitation in activities; (ii) the child may have some activity limitation, but only in lively games; (iii) the child has limitations in daily life with regard also to quiet activities; (iv) at least during some attacks the child lies down with closed eyes or in the dark; (v) during each attack the child lies down with closed eyes or in the dark. The least important variables for the identification of the five behaviour types were studying at school and absence from school. There are some limitations in considering child's behaviour as a measure of attack intensity/disability; one of these is the fact that it was found to be related to the educational level of the mother. However, behaviour during attacks, reported by the child or the parent, provides useful information independently of child's age and, together with the score of pain, when this is given, it can be used as measure of attack intensity.
