Top

Published in:

Open Access 01-12-2022 | Migraine | Research

Functional improvement in children and adolescents with primary headache after an interdisciplinary multimodal therapy program: the DreKiP study

Authors: Hanna Sobe, Matthias Richter, Reinhard Berner, Maja von der Hagen, Antje Hähner, Ingo Röder, Thea Koch, Rainer Sabatowski, Anna Klimova, Gudrun Gossrau

Published in: The Journal of Headache and Pain | Issue 1/2022

Abstract

Background

More than 2/3 of children and adolescents in Germany regularly suffer from headaches. Headache-related limitations in everyday life, school drop-out and educational impairment are common. Structured therapy programs for young headache patients are widely missing.

Methods

One hundred eleven patients with frequent migraine and/or tension type headache were treated in a 15 hour group program in afternoons, parallel with school, parents received 7 hours of therapy. At the beginning of the program (T0), 6 (T1) and 12 months (T2) after completion, data on headache related disability (PedMidas), headache frequency, intensity, and pediatric pain disability score (PPDI) were prospectively collected to investigate the effects of the therapy.

Results

Seventy-five patients (9-19 years, median = 14; 66.7% female) and their parents provided patient reported outcome measures showing at T1 (65 patients) and T2 (47 patients) reduced headache frequency (last 3 months headache days median T0: 30 days; T1: 18 days, reduction of median 12 days since T0; T2: 13 days, reduction of median 17 days since T0). Linear mixed models revealed significant reduction (T0/T1 p = 0,002; T0/T2 p = 0,001). Reduced headache disability has been reported at T1 and T2 (PedMidas median T0 = 30, T1 = 15, T2 = 7; p < 0,001, p < 0,001 respectively). Follow up data of a subgroup of patients 24 months after the treatment point to sustainable effects.

Conclusions

The interdisciplinary multimodal headache therapy program DreKiP reduces headache frequency and headache related disability significantly 6-12 months following its completion.

Trial registration

DRKS00027523, retrospectively registered.

Available only for authorised users

Goodman JE, McGrath PJ (1991) The epidemiology of pain in children and adolescents: a review. Pain 46:247–264. https://doi.org/10.1016/0304-3959(91)90108-ACrossRefPubMed

Nieswand V, Richter M, Berner R et al (2019) The prevalence of headache in German pupils of different ages and school types. Cephalalgia Int J Headache 39:1030–1040. https://doi.org/10.1177/0333102419837156CrossRef

Nieswand V, Richter M, Gossrau G (2020) Epidemiology of headache in children and adolescents-another type of Pandemia. Curr Pain Headache Rep 24:62. https://doi.org/10.1007/s11916-020-00892-6CrossRefPubMedPubMedCentral

Bille B (1997) A 40-year follow-up of school children with migraine. Cephalalgia Int J Headache 17:488–491; discussion 487. https://doi.org/10.1046/j.1468-2982.1997.1704488.xCrossRef

Bille B (1981) Migraine in childhood and its prognosis. Cephalalgia Int J Headache 1:71–75. https://doi.org/10.1111/j.1468-2982.1981.tb00012.xCrossRef

Brna P, Dooley J, Gordon K, Dewan T (2005) The prognosis of childhood headache: a 20-year follow-up. Arch Pediatr Adolesc Med 159:1157–1160. https://doi.org/10.1001/archpedi.159.12.1157CrossRefPubMed

Larsson B, Sigurdson JF, Sund AM (2018) Long-term follow-up of a community sample of adolescents with frequent headaches. J Headache Pain 19:79. https://doi.org/10.1186/s10194-018-0908-5CrossRefPubMedPubMedCentral

Pogliani L, Spiri D, Penagini F et al (2011) Headache in children and adolescents aged 6-18 years in northern Italy: prevalence and risk factors. Eur J Paediatr Neurol EJPN Off J Eur Paediatr Neurol Soc 15:234–240. https://doi.org/10.1016/j.ejpn.2010.11.005CrossRef

Logan DE, Donado C, Kaczynski K et al (2021) From one pain to many: the emergence of overlapping pains in children and adolescents. Clin J Pain 37:404–412. https://doi.org/10.1097/AJP.0000000000000939CrossRefPubMed

10.

Straube A, Heinen F, Ebinger F, von Kries R (2013) Headache in school children: prevalence and risk factors. Dtsch Arzteblatt Int 110:811–818. https://doi.org/10.3238/arztebl.2013.0811CrossRef

11.

Genizi J, Gordon S, Kerem NC et al (2013) Primary headaches, attention deficit disorder and learning disabilities in children and adolescents. J Headache Pain 14:54. https://doi.org/10.1186/1129-2377-14-54CrossRefPubMedPubMedCentral

12.

Rocha-Filho PAS, Santos PV (2014) Headaches, quality of life, and academic performance in schoolchildren and adolescents. Headache 54:1194–1202. https://doi.org/10.1111/head.12394CrossRefPubMed

13.

Albers L, von Kries R, Heinen F, Straube A (2015) Headache in school children: is the prevalence increasing? Curr Pain Headache Rep 19:4. https://doi.org/10.1007/s11916-015-0477-0CrossRefPubMed

14.

Gazerani P (2021) Migraine and mood in children. Behav Sci Basel Switz 11:52. https://doi.org/10.3390/bs11040052CrossRef

15.

Li A, Guessoum SB, Ibrahim N et al (2021) A systematic review of somatic symptoms in school refusal. Psychosom Med 83:715–723. https://doi.org/10.1097/PSY.0000000000000956CrossRefPubMed

16.

Richter M, Gruhl E, Lautenschläger E et al (2018) DreKiP - an outpatient treatment program for children and adolescents with headache. Schmerz Berl Ger 32:17–29. https://doi.org/10.1007/s00482-017-0245-7CrossRef

17.

(2018) Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia Int J Headache 38:1–211. https://doi.org/10.1177/0333102417738202

18.

Stemberger M, Schmit E, Czepa D et al (2014) Climbing therapy under PK-tailored prophylaxis. Hamostaseologie 34(Suppl 1):S13–S16. https://doi.org/10.5482/HAMO-14-01-0003CrossRefPubMed

19.

Lötsch J, Hähner A, Gossrau G et al (2016) Smell of pain: intersection of nociception and olfaction. Pain 157:2152–2157. https://doi.org/10.1097/j.pain.0000000000000599CrossRefPubMed

20.

Hershey AD, Powers SW, Vockell AL et al (2001) PedMIDAS: development of a questionnaire to assess disability of migraines in children. Neurology 57:2034–2039. https://doi.org/10.1212/wnl.57.11.2034CrossRefPubMed

21.

Hübner B, Hechler T, Dobe M et al (2009) Pain-related disability in adolescents suffering from chronic pain. Preliminary examination of the pediatric pain disability index (P-PDI). Schmerz Berl Ger 23:20–32. https://doi.org/10.1007/s00482-008-0730-0CrossRef

22.

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition - PubMed. https://pubmed.ncbi.nlm.nih.gov/29368949/. Accessed 13 Jun 2022

23.

Benore E, Webster EE, Wang L, Banez G (2018) Longitudinal analysis of patient-reported outcomes from an interdisciplinary pediatric pain rehabilitation program for children with chronic migraine and headache. Headache 58:1556–1567. https://doi.org/10.1111/head.13389CrossRefPubMed

24.

Lateef T, He J-P, Nelson K et al (2019) Physical-mental comorbidity of pediatric migraine in the Philadelphia neurodevelopmental cohort. J Pediatr 205:210–217. https://doi.org/10.1016/j.jpeds.2018.09.033CrossRefPubMed

25.

Lipton RB, Fanning KM, Buse DC et al (2019) Migraine progression in subgroups of migraine based on comorbidities: results of the CaMEO study. Neurology 93:e2224–e2236. https://doi.org/10.1212/WNL.0000000000008589CrossRefPubMedPubMedCentral

26.

Gaul C, van Doorn C, Webering N et al (2011) Clinical outcome of a headache-specific multidisciplinary treatment program and adherence to treatment recommendations in a tertiary headache center: an observational study. J Headache Pain 12:475–483. https://doi.org/10.1007/s10194-011-0348-yCrossRefPubMedPubMedCentral

27.

Gunreben-Stempfle B, Griessinger N, Lang E et al (2009) Effectiveness of an intensive multidisciplinary headache treatment program. Headache 49:990–1000. https://doi.org/10.1111/j.1526-4610.2009.01448.xCrossRefPubMed

28.

Krause SJ, Stillman MJ, Tepper DE, Zajac D (2017) A prospective cohort study of outpatient interdisciplinary rehabilitation of chronic headache patients. Headache 57:428–440. https://doi.org/10.1111/head.13020CrossRefPubMed

29.

Gerber W-D, Petermann F, Gerber-von Müller G et al (2010) MIPAS-family-evaluation of a new multi-modal behavioral training program for pediatric headaches: clinical effects and the impact on quality of life. J Headache Pain 11:215–225. https://doi.org/10.1007/s10194-010-0192-5CrossRefPubMedPubMedCentral

30.

Kropp P, Meyer B, Landgraf M et al (2013) Headache in children: update on biobehavioral treatments. Neuropediatrics 44:20–24. https://doi.org/10.1055/s-0032-1333434CrossRefPubMed

31.

Rapoff MA, Connelly M, Bickel JL et al (2014) Headstrong intervention for pediatric migraine headache: a randomized clinical trial. J Headache Pain 15:12. https://doi.org/10.1186/1129-2377-15-12CrossRefPubMedPubMedCentral

32.

Albers L, Heinen F, Landgraf M et al (2015) Headache cessation by an educational intervention in grammar schools: a cluster randomized trial. Eur J Neurol 22:270–276, e22. https://doi.org/10.1111/ene.12558CrossRefPubMed

33.

Kroner JW, Hershey AD, Kashikar-Zuck SM et al (2016) Cognitive behavioral therapy plus amitriptyline for children and adolescents with chronic migraine reduces headache days to ≤4 per month. Headache 56:711–716. https://doi.org/10.1111/head.12795CrossRefPubMed

34.

Hechler T, Ruhe A-K, Schmidt P et al (2014) Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: randomized controlled trial of efficacy and economic effects. Pain 155:118–128. https://doi.org/10.1016/j.pain.2013.09.015CrossRefPubMed

35.

Shulman J, Conroy C, Cybulski A et al (2022) Does intensive interdisciplinary pain treatment improve pediatric headache-related disability? Disabil Rehabil 44:194–201. https://doi.org/10.1080/09638288.2020.1762125CrossRefPubMed

36.

Stahlschmidt L, Zernikow B, Wager J (2016) Specialized rehabilitation programs for children and adolescents with severe disabling chronic pain: indications. Treatment and Outcomes Child Basel Switz 3:E33. https://doi.org/10.3390/children3040033CrossRef

37.

Buzasi E, Kurakata H, Gandhi A et al (2022) Effects of booster sessions on self-management interventions for chronic musculoskeletal pain: a systematic review and meta-analysis of randomised controlled trials. Pain 163:214–257. https://doi.org/10.1097/j.pain.0000000000002302CrossRefPubMed

38.

Faria V, Erpelding N, Lebel A et al (2015) The migraine brain in transition: girls vs boys. Pain 156:2212–2221. https://doi.org/10.1097/j.pain.0000000000000292CrossRefPubMed

39.

Stahlschmidt L, Friedrich Y, Zernikow B, Wager J (2018) Assessment of pain-related disability in pediatric chronic pain: a comparison of the functional disability inventory and the pediatric pain disability index. Clin J Pain 34:1173–1179. https://doi.org/10.1097/AJP.0000000000000646CrossRefPubMed

40.

Scher AI, Buse DC, Fanning KM et al (2017) Comorbid pain and migraine chronicity: the chronic migraine epidemiology and outcomes study. Neurology 89:461–468. https://doi.org/10.1212/WNL.0000000000004177CrossRefPubMedPubMedCentral

Title: Functional improvement in children and adolescents with primary headache after an interdisciplinary multimodal therapy program: the DreKiP study
Authors: Hanna Sobe
Matthias Richter
Reinhard Berner
Maja von der Hagen
Antje Hähner
Ingo Röder
Thea Koch
Rainer Sabatowski
Anna Klimova
Gudrun Gossrau
Publication date: 01-12-2022
Publisher: Springer Milan
Keywords: Migraine
Tension Headache
Headache
Published in: The Journal of Headache and Pain / Issue 1/2022
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI: https://doi.org/10.1186/s10194-022-01481-1

At a glance: The STEP trials

Springer Medicine

Functional improvement in children and adolescents with primary headache after an interdisciplinary multimodal therapy program: the DreKiP study

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2022

A real-world study of acute and preventive medication use, adherence, and persistence in patients prescribed fremanezumab in the United States

Insular functional connectivity in migraine with aura

Headache, anosmia, ageusia and other neurological symptoms in COVID-19: a cross-sectional study

Hypoperfusion in nucleus accumbens in chronic migraine using 3D pseudo-continuous arterial spin labeling imaging MRI

A study to investigate the prevalence of headache disorders and migraine among people registered in a health insurance association in Japan

Resting-state magnetoencephalographic oscillatory connectivity to identify patients with chronic migraine using machine learning