Academic journal article The Journal of Early and Intensive Behavioral Intervention

Recurrent Pediatric Headaches: Behavioral Concepts and Interventions

Academic journal article The Journal of Early and Intensive Behavioral Intervention

Recurrent Pediatric Headaches: Behavioral Concepts and Interventions

Article excerpt


Recurrent pediatric headaches are increasingly understood to be a function of both respondent and operant processes. In particular, the environment is thought to elicit internal autonomic instability and to evoke external maladaptive pain behavior. While medical interventions often provide an appropriate first line treatment, behavioral interventions can provide an important adjunct to medical intervention and in some cases provide valuable alternative sources of relief. This article reviews the prevalence, types, and functional impairments associated with recurrent pediatric headaches and the behavioral concepts that help explain their etiology. The article also reviews the substantial empirical research that supports the efficacy of behavioral interventions. These include teaching children to control autonomic reactivity through relaxation or biofeedback and then arranging for an environment that reinforces use of these tools. The article concludes with a discussion of future directions for research in biofeedback, including the application of behavioral concepts and interventions to other chronic health related problems in children.

Key Words: headaches, biofeedback, migraine, pediatric, behavioral interventions.


Recurrent pediatric headaches represent a clinically significant health problem for many children and youth. Over a third of all adolescents in the United States complain about headaches in general (US Dept Health and Human Service, 2003), and headaches are among the most common clinical problems encountered in schools (Peterson, Bergstrom & Brulin, 2003; Schneider, Friedman, & Fisher, 1995). Although prevalence rates vary, actual recurrent headaches appear in about 10% of all preadolescent children and up to 15% of all adolescents (Hershey, 2005; Mortimer, Kay, & Jaron, 1992; Newacheck & Taylor, 1992). In general, recurrent pediatric headaches (a) typically first appear around 6-7 years of age, (b) become more prevalent with age, (c) present more frequently in preteen boys than preteen girls, and (d) present more frequently in adolescent girls than adolescent boys (Abu-Arafeh & Russell, 1994; McGrath & Hillier, 2001).

Pediatric headaches are particularly problematic because they can result in increased health care utilization (Stang, Osterhaus, & Celentano, 1994) and can result in prolonged absences from school (Cannon & Compton, 1980; Stang & Osterhaus, 1992). Empirical studies have found significant morbidity in terms of lost time at school (e.g., Lee & Olness, 1996). For example, children who experience recurrent headaches have been found to miss 2.5 times more school days than children who are headache free (Abu-Arefeh & Russell, 1994). In addition, children and youth with recurrent headaches are at risk for more social withdrawal, impaired school performance, and decreased ability to cope with demands in the classroom (e.g., Poznanski, 1982; Reynolds, 1991; Shaw, 1988). Overall, children with recurrent headaches have been found to experience impairment in school and social functioning comparable to other children with significant chronic diseases (e.g., Powers, Patton, Hommel, & Hershey, 2003).

Recurrent headaches are characterized by repeated painful episodes experienced across several months that occur in the absence of a well-defined medical cause. The most common recurrent headaches in children are migraine headaches (characterized by sharp, throbbing, moderate to severe pain), and tension headaches (characterized by dull, mild to moderate diffuse pain). Although the most common differentiation between the two types of recurrent headaches involves intensity and frequency (i.e., migraine headaches are typically infrequent and intense; tension headaches are typically frequent and moderate), in practice, there is a good deal of overlap across these two types of recurrent headaches. …

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