Biopsychosocial treatment response among youth with continuous headache: A retrospective, clinic-based study

Background: Youth with continuous (always present) headache are vastly understudied; much remains to be understood regarding treatment response in this population. Objective: To describe and explore biopsychosocial factors related to initial clinical outcomes among treatment-seeking youth with continuous headache. Methods: This retrospective cohort study extracted data of 782 pediatric patients (i.e., aged <18 years) with continuous headache from a large clinical repository. Youth in this study had experienced continuous headache for >= 1 month before presenting to a multidisciplinary headache specialty clinic appointment. Extracted data from this appointment included patients' headache history, clinical diagnoses, and headache-related disability, as well as information about biopsychosocial factors implicated in headache management and/or maintenance (e.g., healthy lifestyle habits, history of feeling anxious or depressed). Additional data regarding patient headache characteristics, disability, and lifestyle habits were extracted from a subset of 529 youth who returned to clinic 4-16 weeks after their initial follow-up visit. After characterizing initial treatment response, exploratory analyses compared youth with the best and worst treatment outcomes on several potentially influential factors. Results: Approximately half of youth (280/526; 53.2%) continued to have continuous headache at follow-up, similar to 20% of youth (51/526) reported a significant (>= 50%) reduction in headache frequency. Improvements in average headache severity (e.g., percentage with severe headaches at initial visit: 45.3% [354/771]; percentage with severe headaches at follow-up visit: 29.8% [156/524]) and headache-related disability were also observed (e.g., percentage severe disability at initial visit: 62.9% [490/779]; percentage severe disability at initial follow-up visit: 34.2% [181/529]). Individuals with the worst headache frequency and disability had a longer history of continuous headache (mean difference estimate = 5.76, p = 0.013) and worse initial disability than the best responders (chi(2)[3, 264] = 23.49, p < 0.001). They were also more likely to have new daily persistent headache (chi(2)[2, 264] = 12.61, p = 0.002), and were more likely to endorse feeling depressed (chi(2)[1, 260] = 11.46, p < 0.001). Conclusion: A notable percentage of youth with continuous headache show initial improvements in headache status. Prospective, longitudinal research is needed to rigorously examine factors associated with continuous headache treatment response.

Automated summary

This retrospective cohort study examined the factors related to initial clinical outcomes among treatment-seeking youth with continuous headache. The results showed that a significant percentage of youth experienced improvements in headache status after treatment. Those with worse treatment outcomes had a longer history of continuous headache, higher disability, higher likelihood of new daily persistent headache, and higher likelihood of feeling depressed.