Physical Stress Often Precedes Daily Headache

LOS ANGELES – New daily persistent headache in children and adolescents appeared to be most often caused by a physical stress, viral illness, or minor head trauma, according to study findings reported by Dr. Kenneth Mack at the annual meeting of the American Headache Society.

Illnesses preceded the onset of new daily persistent headache (NDPH) in 43% of the 40 patients studied (range 12–18 years). Most common was infection with the Epstein Barr virus, accounting for more than half of those illnesses, said Dr. Mack, a neurologist at the Mayo Clinic, Rochester, Minn.

Minor head trauma accounted for 23%, while head surgery and idiopathic intracranial hypertension each was associated with 10% of the cases.

The onset of NDPH followed an appendectomy in one patient and high altitude climbing in another. Five patients had no identifiable inciting events.

Dr. Mack compared his results from this study with a follow-up study of 94 children (aged 7–18 years) who had a history of episodic migraines that evolved into transformed migraines.

He found that the transformed migraines that were abruptly triggered followed an illness 46% of the time and were triggered by minor head trauma 18% of the time, while individual cases were triggered by idiopathic intracranial hypertension or developed after surgery. In 25% of cases there were no identifiable preceding events.

Other etiologies that have been proposed for the onset of daily headache include analgesic overuse, psychological stress, caffeine, alcohol, and hypothyroidism, but Dr. Mack found no evidence of these in his study.

Dr. Mack noted that the onset of symptoms of NDPH and transformed migraines are very similar, as are the comorbid symptoms. He proposed that this may indicate that NDPH may be one of the first signs of transformed migraine in some patients.