Classification of Children with Chronic Headache from Children without Headache by Stress-Related Biological and Psychological Characteristics

Rapid Communication

Austin Child Adolesc Psychiatry. 2022; 6(1): 1019.

Classification of Children with Chronic Headache from Children without Headache by Stress-Related Biological and Psychological Characteristics

Simone Bung, Helmut Saile and Reinhold Laessle*

University of Trier, Frauenstr 7, 54290 Trier, Germany

*Corresponding author: Reinhold Laessle, University of Trier, Frauenstr 7, 54290 Trier, Germany

Received: December 30, 2021; Accepted: January 25, 2022; Published: February 01, 2022


Stress-related psychological and biological characteristics were used to classify young girls to predict girls with chronic headache. This was done by stepwise discriminant function analysis that included at each step biological and psychological characteristics of stress load and stress coping to identify the best predictive power which was evaluated by canonical correlation coefficients. At each step psychological stress load was significant. Lack of problem-solving and seeking social support were important. Also passive avoidance and destructive stress coping. The best classification quality was obtained, when depression and anxiety of the children were included in discriminant function. Hyperactivity of HPA axis did not play an important role.

Keywords: Headache; Adolescents; Stress load; Cortisol; Classification


Chronic headache in children and adolescents is frequent. A metaanalysis of [1] was based on data of 50 studies, which were published worldwide and included 80,000 patients. Lifetime prevalence of chronic headache was 58.4%. For migraine in particular 7, 7% are reported, whereby the prevalence for girls is greater than for boys.

Stress load in daily life of adolescents with chronic headache is heightened, which has been shown in a study of [2] in 113 school girls.

The interrelationship between stress and headache in the longterm has been confirmed also by [3].

A very high stress load in university students with chronic headache was observed in a case-control study of [4]. When a high stress load was present in young college students, headache was significantly more present than other somatic complaints [5].

School absenteeism as an indicator of stress load has been found in adolescents with chronic headache by [6].

On the other hand stress coping of youth with chronic headache is characterized by widely in adequate strategies. This has been demonstrated in a study of [7] by using projective test methods.

The empirical evidence suggests that girls with headache are suffering from more stress load and on the other hand are not able to cope adequately with stress. The present investigation is an attempt to confirm previous results. As an extension to previous research a classification in girls with and without headache using stress related biological and psychological characteristics by discriminant function analysis was done.


All participants with headache were recruited in schools and had to fulfill ICHD-3 criteria for migraine or tension-type headache. The control group was recruited on the University campus in Trier. Before participation, acute diseases were excluded by a medical doctor.

20% of the girls fulfilled the criteria for migraine, 70% criteria for tension-type headache, the rest could not be classified definitely.

Stress load was assessed by the questionnaire for stress and stress coping for children and adolescents (SSKJ) [8].

The subscales comprise: 1) Vulnerability to stress; 2) Physical symptoms of stress such as headache, stomach ache or exhaustion; 3) Psychological symptoms of stress such as depressed mood and anxiety.