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From the Departments of Neurology (Drs. Bigal and Lipton) and Epidemiology and Population Health (Dr. Lipton), Albert Einstein College of Medicine, New York; The New England Center for Headache (Drs. Bigal, Tepper, Rapoport, and Sheftell), Stamford, CT; Department of Neurology (Dr. Tepper), Yale University School of Medicine, New Haven, CT; Department of Neurology (Dr. Rapoport), Columbia University College of Physicians & Surgeons, New York; and Department of Psychiatry (Dr. Sheftell), New York Medical College, NY.
Address correspondence and reprint requests to Dr. Marcelo E. Bigal, Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Bronx, NY 10461; mbigal{at}aecom.yu.edu
Objectives: To determine the relative frequency of chronic daily headache (CDH) subtypes in adolescents and to compare the distribution of CDH subtypes in adolescents and adults of various ages.
Methods: Adolescents (13 to 17 years, n = 170) and adults (18 or older, n = 638) were recruited during the same time frame. CDH subtypes were classified according the criteria proposed by Silberstein and Lipton (1996) as transformed migraine (TM), chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC).
Results: Among adolescents and adults there were substantial differences in the distribution of CDH subtypes. The relative frequency of TM was lower in adolescents (68.8% vs 87.4%, p < 0.001), while NDPH (21.1% vs 10.8%, p < 0.001) and CTTH (10.1% vs 0.9%, p < 0.0001) were more common. HC (0 vs 0.9%, NS) was equally rare. The lower relative frequency of TM in adolescents was accounted for by TM with medication overuse (TM+), much more common in adults (28.2% vs 62.5%, p < 0.001). In fact, TM without medication overuse (TM–) was more common in adolescents (40.5% vs 24.9%, p < 0.001). The relative frequency of TM+ increased until the age of 50 years (p < 0.001).
Conclusions: In adolescents with CDH, TM usually develops without medication overuse. Adolescents with the early onset form of TM may develop the disorder in the absence of medication overuse because they are at increased biologic risk.
Received April 5, 2004. Accepted in final form May 14, 2004.
Related Article
Neurology 2004 63: 766-767.
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