More headaches in adolescents during COVID-19 pandemic

A Turkish study found evidence that the long-term psychosocial impact of the COVID-19 pandemic translates into worsening headache among adolescents. Over one third of schoolchildren who received online teaching during the COVID-19 pandemic reported worsening headache symptoms or new-onset headaches.

Though initially it seemed that the lockdown potentially had an improvement on headache in children due to reduced school-related stress, the long-term effect of the pandemic on headache in adolescents remained unknown. The current study analysed 851 adolescents who were admitted to the outpatient clinic of the Ermenek State Hospital in Istanbul, Turkey [1]. Participants were between 10 and 18 years of age and 531 (62%) were girls. Of them, 756 (89%) reported headaches over the study period. Among the group of children with headaches, 10% reported new-onset headaches over the pandemic home-schooling period, while headaches worsened in 27%, remained stable in 61%, and improved in 3% (P<0.001). COVID-19 positivity was not more prevalent in the group with headache (15%) versus no headache (18%; P=0.432).

Headache severity was significantly increased with age (correlation coefficient [R]=0.176; P<0.001), headache duration (R=0.188; P<0.001), depression (R=0.212; P<0.001), generalised anxiety (R=0.306; P<0.001), and COVID-19-related anxiety (R=0.107; P<0.01). Headache frequency was significantly increased with age (R=0.127; P<0.001), depression (R=0.219; P<0.001), and generalised anxiety (R=0.284; P<0.001).

Those who reported worsened or new-onset headaches, had headaches on average 8–9 times per month. Risk factors for new-onset or worsening of headache during the pandemic were:

• Prolonged exposure to a computer screen: odds ratio (OR) 1.7 (P<0.01);
• A lack of suitable conditions for online learning at home: OR 2.6 (P<0.001);
• School exams: OR 1.7 (P<0.001);
• Living in a city: OR 1.6 (P<0.05);
• Female sex: OR 1.8 (P<0.01);
• Weight gain: OR 1.6 (P<0.01);
• Depression: OR 2.0 (P<0.001); and
• COVID-19-related anxiety: OR 3.2 (P<0.01).

Dr Ayşe Nur Özdag Acarli (Ermenek State Hospital, Turkey) said that in contrast to previous reports, this analysis did not show a tendency towards reduction in headache and headache severity during the pandemic. She also noted that 62% of respondents said they were dissatisfied with the quality and sufficiency of online education. Dr Acarli and her group concluded that headache triggered by a screen during online education may contribute to the feeling of decreased school performance, and thus anxiety and depression.

These study results emphasise the importance of preserving children and adolescents from electronic screen exposure. Traditional school attendance might be better than online education, at least for adolescents with headaches that are triggered by electronic screens. More psychological support and limiting screen time in adolescents would help improve or eliminate adolescents’ headache episodes.

1. Acarli AO, et al. The burden of coronavirus disease (COVID-19) pandemic on headaches in adolescents: Other side of the coin. EPO-070, EAN 2022, 25–28 April, Vienna, Austria.

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Posted on 22 August, 2022