Severe or recurrent headache or migraine in children and adolescents is linked to several important risk factors for long-term vascular morbidity, according to the results of a study reported in the April issue of theArchives of Pediatrics & Adolescent Medicine.

"The clinical significance of recurrent headaches in childhood and their association with comorbidities and biologic correlates suggest that, despite difficulties in their subclassification in NHANES [National Health and Nutrition Survey] and more broadly, pediatric headache is an important disorder," write Karin B. Nelson, MD, from the National Institute of Mental Health in Bethesda, Maryland, and colleagues. "We examined the association between headaches and vascular or inflammatory biomarkers including CRP [C-reactive protein], homocysteine, folate, lipid, and uric acid levels and platelet counts and their interrelationships in children. Other well-established correlates of headaches and/or vascular biomarkers including age, sex, ethnicity, poverty income ratio (PIR) (proxy for social class), and BMI [body mass index] were also included."

The goal of this study was to determine the association of childhood headache disorders with markers of cardiovascular and cerebrovascular disease risk, using data from NHANES, a nationally representative health survey.

In a population of 11,770 NHANES participants from 1999 through 2004 who were 4 to 19 years old, the investigators looked at the relationship of headache with BMI; CRP; homocysteine levels; serum and red blood cell folate levels; vitamin B12; methylmalonic acid levels; total cholesterol, high-density lipoprotein (HDL) cholesterol, and non-HDL cholesterol levels; triglyceride levels; uric acid levels; and platelet count.

Compared with children without headaches, children with headaches had higher mean BMI, CRP levels, and homocysteine levels, and they also had lower serum and red blood cell folate levels. More children with headaches were in the highest quintile of risk for these factors, as well as in the highest quintile of risk of having at least 3 or more of these factors.

"Several important risk factors for long-term vascular morbidity cluster in children and adolescents with severe or recurrent headache or migraine," the study authors write. "Further study and screening of children with headaches may permit improved preventive management."

Limitations of this study include those inherent in using NHANES as a data source.

"Risk of asymptomatic vascular disease can be identified early, and severity rises with increasing number of risk factors," the study authors conclude. "Such young people may be an appropriate target for further study and for screening, follow-up, and efforts to prevent long-term vascular pathology and resulting cardiovascular disease and stroke."

The National Institute of Mental Health and National Institute of Neurological Disorders and Stroke intramural research programs supported this study. The study authors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2010;164:358-362. Abstract

Laurie Barclay, MD • Medscape Medical News © 2010 Medscape, LLC