Headache, mood disorders increase among pediatric patients during COVID-19 pandemic
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Pediatric patients with headache experienced increased headache frequency, poorer anxiety and mood, less physical activity and more screen time during the COVID-19 pandemic, despite reported improvements in hydration, sleep and diet.
The researchers from Children’s National Health System in Washington, D.C., presented their findings from a patient-reported questionnaire during the American Headache Society Virtual Annual Scientific Meeting.
“Pediatric headache is really common. If you add up all the asthma and diabetes in the United States, that is equivalent to the number of patients with migraine. It is a huge, huge public health concern,” Marc DiSabella, DO, director of the headache program and the child neurology fellowship program and medical director of neurology education at Children’s National, told Healio Neurology. “Kids are really impacted by it. The morbidity associated with pediatric headache is four times that of a pediatric brain tumor diagnosis. That is how much it plays a role in your life, because you just do not know what is going to happen.”
DiSabella and colleagues began seeing trends in their pediatric patients with headache during the COVID-19 pandemic, which included children doing better and doing worse. In the present study, they aimed to determine the reasons for these changes.
“A big part of headache care is talking about lifestyle modifications, which includes hydration, exercise, sleep and diet goals and how to use screens appropriately,” he continued. “All of these things were altered during the pandemic.”
Impact of lifestyle
The researchers examined children seen at the Children’s National Hospital headache clinic between summer 2020 and winter 2021. Patients filled out a questionnaire that looked at changes in headache characteristics and lifestyle factors since the pandemic began.
The study included 113 pediatric patients with headache. The study population comprised more girls than boys (60% vs. 40%) and more than half the children were aged 12 to 17 years (63%). The most common diagnoses included chronic migraine (37%), migraine with aura (22%), migraine without aura (19%) and new daily persistent headache (15%).
DiSabella and colleagues found that percentage of patients who reported the same amount of, or more physical activity (46%) was similar to those reporting less physical activity (54%) since the start of the pandemic. Most children (79%) reported eating the same amount of, or more food since the start of the pandemic, while a smaller percentage (21%) reported eating less. A similar percentage of children (84%) reported drinking the same amount of, or more fluids since the pandemic started compared with those reporting decreased fluid intake (16%) during that time. Most children (78%) also reported getting the same or better quality of sleep compared with 22% of children who reported less sleep since the pandemic started.
“Most patients, at least by report, said they were drinking better, sleeping better and eating better, but exercising less. That was not too surprising to us, but of the sleep, hydration, exercise and diet goals, the one with probably the best evidence for its effectiveness is aerobic activity,” DiSabella said. “That was an important thing to recognize, because when we look at why are these kids having worsening headaches, if there is something we are going to look closer at, it will probably be physical activity.”
Changes in headache type, mood
The researchers also looked at changes in headache type and mood over the course of the pandemic, as well as screen time. DiSabella and colleagues found that episodic headaches decreased from 70% before the pandemic to 51% since the start of the pandemic, while chronic or daily headache disorders increased from 30% to 49% and constant daily headaches increased from 20% to 32%. Nearly half of all patients (46%) said their headaches had worsened since the start of the pandemic, according to the study results. Approximately half of the patients reported worse anxiety (55%) and mood (48%), as well as feeling more stressed (55%). A small percentage (12%) said they felt less stress, the researchers noted. Moreover, slightly more than half of patients (55%) reported that their school workload was the same or better since the start of the pandemic. More than half of the respondents (62%) said screen time use was exacerbating their headaches.
“There’s a headache disorder called new daily persistent headache in which people have a headache every day, all the time. It is the most resistant disorder to any sort of management,” DiSabella said. “In our population, we saw almost a doubling of new daily persistent headaches. That is a big, big number.”
He also noted that “a lot of factors” were affecting pediatric patients with headache during the pandemic.
“Despite patients engaging in most of the lifestyle recommendations, excluding exercise, that we suggest for headache, they were still having worsening headache and anxiety. It may be that the benefits of lifestyle modification and all the things we thought were really important are outweighed by the benefits of being social and being around other kids,” DiSabella said. “A lot of kids were fearful about what was going to happen to them or their families or their grandparents, and fear was driving more of our anxiety. We were also taken away from our social circles, which is where we got a lot of our reassurance in life.”