IDIOPATHIC HEADACHE IN CHILDHOOD AND ADOL ESCENCE

This review of the literature covers classification, epidemiology and clinical aspects of idiopathic headache in childhood and adolescence. In addition, pathogenetic models taking into account the complex invol vement of organic, psychological and psychosocial factors are critical ly reviewed. A general pathogenetic model of migraine may be character ized by a given predisposition, various co-factors which enhance the t endency, and finally, trigger mechanisms which induce an attack. No ge nerally accepted model exists for tension type headache. In assessing the importance of various factors thaught to be related to idiopathic headache, it is necessary to differentiate between causal relation, un specific association, and coincidence. The aim of this review is to pr esent potential factors influencing headache in childhood and adolesce nce and to discuss these factors critically with regard to their etiop athogenetic importance. Organic factors seem to be most important in m igraine, whereas psychological and (psycho)social factors may influenc e any type of headache. Briefly, migraine in childhood and adolescence seems to be definitively associated with vegetative dysfunction, abdo minal symptoms and hormonal factors and possibly with allergic reactio ns, whereas a relation to epilepsy can be excluded. There is absolutel y no evidence for a typical personality of migraine patients. Various psychic reactions, however, are important in all types of headache. De pression and anxiety in young headache patients seem to be related gen erally to pain, but not specifically to headache. However, school prob lems, learning disabilities and stress coping behaviour seem to be rel ated directly to recurrent headache. Additionally, there is evidence t hat the prevalence of headache is associated with low economic status.