Behavioral and emotional symptoms and primary headaches in children: A population-based study

Objective: To investigate behavioral and emotional symptoms in a community-based sample of children as a function of headache status and of headache frequency. Methods: Our sample consisted of 1,856 children (5-11 years). Primary headaches were assessed using a validated headache questionnaire. Emotional symptoms were assessed by the Child Behavior Checklist (CBCL). CBCL scores were modeled as a function of headache status after adjustments for demographics and headache frequency. Results: Relative to controls, children with migraine were significantly more likely to have abnormalities in the following CBCL domains: somatic, anxiety-depressive, social, attention, internalizing and total score. Children with tension-type headache (TTH) were significantly different from controls in the same domains but at a lower rate than migraine. In children with migraine, impairments significantly varied as a function of headache frequency, race, and income. In children with TTH, gender, age, and headache frequency were significantly associated with abnormal scores. Conclusions: Migraine and TTH are significantly associated with behavioral symptoms in several domains, and headache frequency affects the association. Internalizing symptoms are common in children with headaches, while externalizing symptoms (e. g. rule-breaking and aggressivity) are not significantly more common than in controls.