Incidence and Risk Factors of Chronic Daily Headache in Young Adolescents: A School Cohort Study WHAT’S KNOWN ON THIS SUBJECT: Several studies have investigated the prevalence of chronic daily headache (CDH) and analyzed the risk factors for its persistence. However, the etiologic factors that lead to new-onset CDH remain unsettled in adolescents. WHAT THIS STUDY ADDS: This study was the first incidence study of CDH conducted in young adolescents. We reported the incidence rates and found that some risk factors for incident chronic migraine and chronic tension-type headache were different. abstract OBJECTIVES: This study investigated the incidence and risk factors of chronic daily headache (CDH) and its major subtypes in young ado- lescents. METHODS: A field cohort of 3342 adolescents aged 13 to 14 was estab- lished in 3 middle schools in Taitung, Taiwan, from 2005 to 2007. Par- ticipants without CDH at baseline were annually followed up for 1 to 2 years using the same questionnaires, including the Adolescent Depres- sion Inventory and Pediatric Migraine Disability Assessment. The neu- rologists made the headache diagnoses based on clinical interviews and headache diaries. The person-time incidence rates and risk factors of incident CDH and its subtypes (ie, chronic migraine [CM] and chronic tension-type headache [CTTH]) were calculated by using Cox proportional hazards models. RESULTS: The cohort completed 5586 person-years (PYs) of follow-up. Sixty-three subjects (21 boys/42 girls) developed incident CDH with an incidence rate of 1.13 per 100 PYs, including 37 with CM (0.66 per 100 PYs) and 22 with CTTH (0.39 per 100 PYs). Thirty-three subjects (52%) had a baseline diagnosis of migraine. The independent risk factors for incident CDH included female gender, acute family financial distress, obesity, higher headache frequency, and a baseline diagnosis of migraine. A higher headache frequency was the only identical risk factor for CDH, CM, and CTTH. A baseline diagnosis of migraine and obesity were significant predictors for both CM and CDH. Female gender was a significant predictor for both CTTH and CDH. CONCLUSIONS: Incident CDH was common in young adolescents. Some risk factors for incident CM and CTTH were different. Pediatrics 2013;132:e9–e16 AUTHORS: Shiang-Ru Lu, MD, a Jong-Ling Fuh, MD, b,c,d Shuu- Jiun Wang, MD, b,c,d Kai-Dih Juang, MS, MD, e,f Shih-Pin Chen, MD, PhD, b,d Yi-Chu Liao, MD, PhD, b,g and Yen-Feng Wang, MD b,d a Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan; Departments of b Neurology and e Psychiatry, and c Brain Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan; d Department of Neurology, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan; and Departments of f Psychiatry and g Neurology, Taichung Veterans General Hospital, Taichung, Taiwan KEY WORDS adolescence, incidence, migraine headache, tension-type headache, risk factors ABBREVIATIONS ADI—Adolescent Depression Inventory CDH—chronic daily headache CI—confidence interval CM—chronic migraine CTTH—chronic tension-type headache HR—hazard ratios ICHD-2—International Classification of Headache Disorders, 2nd edition ICHD-2R—revision of ICHD-2 IQR—interquartile ranges MINI-Kid—Mini-International Neuropsychiatric Interview for Chil- dren and Adolescents PedMIDAS—Pediatric Migraine Disability Assessment PYs—person-years Dr Lu collected, analyzed, and interpreted the data and was responsible for drafting and revising the manuscript; Dr Fuh developed the concept, designed the study, collected and analyzed the data, revised the manuscript, and approved the final manuscript as submitted; Dr S.J. Wang developed the concept, designed the study, collected and analyzed the data, drafted the initial manuscript, revised the manuscript, and approved the final manuscript as submitted; Dr Juang developed the concept, designed the study, and collected the data; and Drs Chen, Liao, and Y.F. Wang collected and analyzed the data. (Continued on last page) PEDIATRICS Volume 132, Number 1, July 2013 e9 ARTICLE by guest on October 30, 2021 www.aappublications.org/news Downloaded from