"Stress" is an all encompassing term for psychosocial issues that may precipitate or aggravate headache. This includes depression and anxiety. Emphasize that all patients experience stress. The most common problem areas in pediatrics include family issues, school problems, difficulty with friends, and excessive extracurricular activities.
Problems regarding divorce, blended families, joint custody, substance abuse, and physical and sexual abuse frequently play important roles in providing treatment. In patients with chronic daily headache (CDH), stress regarding over-achievement is often unrecognized.
Frequent school absences are a barometer of stress. Measures to return patients to full attendance are important; even partial attendance is critical in care. Home schooling should be discouraged. Patients with academic struggles are also more prone to headache, and tutoring or special planning can be useful in this setting.
Relationships with fellow students and physical and emotional bullying are being recognized with increased frequency as bringing on or aggravating headache. In addition, many of our patients are overcommitted. Sports, cheerleading, band, debating clubs, and a part-time job not only cause stress but, when combined with excessive homework, adversely impact sleep.
If stressful issues are identified, refer the patient for psychological evaluation. Use adolescent psychologists trained in pain management. Recommendations regarding counseling, biofeedback, or other behavioral methodologies are often very helpful.
Was this article helpful?
Are Headaches Taking Your Life Hostage and Preventing You From Living to Your Fullest Potential? Are you tired of being given the run around by doctors who tell you that your headaches or migraines are psychological or that they have no cause that can be treated? Are you sick of calling in sick because you woke up with a headache so bad that you can barely think or see straight?