Migraine and Tension-Type Headache among Children and Adolescents Presenting to a Headache Clinic – Similarities and Differences

Objective: To compare the key clinical phenotypes of migraine and tension-type headache (TTH), among children and adolescents, presenting to a headache clinic.

Methods: Medical records of children referred for primary headache to the pediatric neurology clinic at Bnai Zion Medical Center from 2008 to 2017 were assessed.

Results: 497 patients, mean age 11.4 years± 3 (range 6–18 years; 58.1% females) met the IHS diagnostic criteria for migraine or TTH and were included in our study. 52% were diagnosed with migraine, 48% with TTH. Those with migraine had more nausea, vomiting, phonophobia and photophobia compared to children with TTH (p=0.001). Headache in the migraine group was described as more severe (moderate–severe pain: 97% vs. 13%, p= 0.001) and as having more of an impact on daily life (interferes with daily activity, yes/no: 60% vs. 9%, p<0.04) compared to the TTH group. Children in the migraine group used more analgesic treatments to stop the headache attacks compared to the TTH group (50% vs. 38%, p=0.001). Patients diagnosed with TTH reported having more emotional difficulties (p = 0.001). No significant differences were found in headache characteristics, frequency or intensity between the younger children (ages 6–11) and the adolescents (ages 12–18) within either group, TTH or migraine.

Conclusions: In our headache clinic, migraine and TTH were equally prevalent, and both constituted a significant burden on our patients` everyday lives. We found no major differences in frequency, intensity, and characteristics of pain between younger children and adolescents.