The frequency and severity of headaches among adolescents increased during the Covid-19 pandemic, suggests a new study presented at the Congress of the European Academy of Neurology (EAN) 2022.¹ Slightly over 60% study subjects who had to shift to online education due to the pandemic reported either worsening of or new onset of headaches.

A total of 851 adolescents, mean age of nearly 15 years, visiting a neurology or pediatric OPD from August–December 2021, were recruited for this multicenter study. More than half (531) were female. Participants with epilepsy, autism spectrum disorder, neurological disorders or intellectual disability were not included in the study group. The participants were assigned to complete questionnaires, which included information about headache, exposure to Covid-19, use of electronics, academic performance. The Patient Health Questionnaire-9, Generalized Anxiety Disorders Scale and Coronavirus Anxiety Scale were used to assess symptoms of depression and anxiety.

Results showed that nearly 90% (n=756) of the study participants complained of headaches. Of these, 10% reported headache as a new symptom, while 27% stated that their headache had worsened, with more severe and frequent episodes of headaches. The headache remained stable in 61%, while it improved in 3% of adolescents. More female than male participants reported headache with female to male ratio of 2:1 vs 1:1.

Participants reporting worsened headaches tended to be female and older in age.

Participants with headache scored high on depression and generalized anxiety scales and among this group, those who reported new onset of headache or worsening of headache had significantly higher scores compared to those with stable and improved headache. Adolescents with depression were at 2-folds higher risk of worsening of their headaches with odds ratio of 2.0.

No association with history of Covid-19 exposure was noted between the two groups; however, Covid-related anxiety was more prevalent in those with worsened headaches versus the stable headache group with OR of 3.2.

Sixty-two percent adolescents who expressed dissatisfaction with online teaching also reported worsening headaches due to longer duration of use of computers (OR 1.7) and unsuitable conditions for online classes (OR 2.6). School exams and weight gain were other factors contributing to the increase in severity of headaches.

This study reiterates the link between severity and frequency of headaches and anxiety or depression, which can either trigger a headache or be an aftermath of severe and frequent headaches. The significant association of headache with online learning, which was the mode of teaching adopted for at least two years of the pandemic due to lockdown and Covid restrictions highlights the psychosocial pressures of the pandemic. Identification of these triggers could allow for appropriate lifestyle modifications to reduce the future episodes of headaches.

Reference

1. Ozdag Acarli, et al. Abstract A-22-03235. The burden of Coronavirus Disease (COVID-19) pandemic on headaches in adolescents: other side of the coin. European Journal of Neurology. 2022;29 (Suppl. 1):416.