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Tension-type headache in children: the Cinderella of headache disorders!

Shashi S Seshia1, Ishaq Abu-Arafeh, Andrew D Hershey

  • 1Division of Pediatric Neurology, Department of Pediatrics (SSS), University of Saskatchewan, Saskatoon, SK, Canada.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|December 8, 2009
PubMed

Insights

Tension-type headache (TTH) is common in children and adolescents, often linked to stress and co-occurring mood disorders. A biopsychosocial approach and therapies like cognitive behavioral therapy are effective for managing TTH.

Area of Science:

  • Neurology
  • Pediatrics
  • Psychology

Background:

  • Tension-type headache (TTH) is a prevalent headache disorder in children and adolescents, comparable in frequency to migraine.
  • TTH has a complex neurobiological basis influenced by genetic and environmental factors.
  • Existing diagnostic criteria for TTH are applicable to pediatric populations.

Purpose of the Study:

  • To review the characteristics, diagnosis, and management of TTH in children and adolescents.
  • To highlight the role of psychosocial factors and comorbidities in TTH.
  • To emphasize the need for increased clinical and scientific recognition of TTH in this age group.

Main Methods:

  • Review of current literature and diagnostic criteria (International Classification of Headache Disorders, 2nd ed.).
  • Discussion of neurobiological underpinnings, genetic and environmental influences.
  • Exploration of comorbid conditions, particularly anxiety and mood disorders.
  • Emphasis on a biopsychosocial approach to management, including standardized histories, examinations, and headache diaries.
  • Identification of 'red flags' for secondary headaches.

Main Results:

  • TTH diagnostic criteria are suitable for children and adolescents.
  • Anxiety and mood disorders are frequently comorbid with episodic and chronic TTH.
  • Psychosocial stressors are significant triggers and maintaining factors for TTH.
  • No randomized controlled drug trials exist for pediatric TTH treatment.
  • Relaxation and cognitive behavioral therapies demonstrate effectiveness.

Conclusions:

  • TTH in children and adolescents requires greater clinical and scientific attention.
  • A biopsychosocial model is essential for effective TTH management in this population.
  • Further research, including studies specifically on TTH, is urgently needed.

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