A first-of-its-kind study with children suggests an association of migraine headache with oppositional defiant disorder but not with attention deficit disorder or conduct disorder, according to a presentation at the 11th Congress of the International Headache Society.

Based on the high prevalence of migraine headaches and behavioral disorders in children, an American research team decided to test for any relationship between a behavioral disorder (specifically, attention deficit disorder, conduct disorder, or oppositional defiant disorder) and migraine headaches.

In the current study, American researchers studied patients ages 6 to 17 years of age who were treated at a university headache clinic. A questionnaire called the Child Symptom Inventory was given to patients (or their parents, if too young to complete), with a psychological interview afterward. A group of age-matched children and adolescents was used as controls.

“Until now, there was no evidence to support comorbidities of behavioral disorders in children with migraines,” said Ann Pakalnis, M.D., study presenter. “Parental reports of disruptive behavior are common in pediatric migraineurs. Children with migraines miss more school and often lose sleep, which can contribute to the types of behavioral symptoms often associated with attention deficit disorder, conduct disorder, or oppositional defiant disorder, but this is the first study to demonstrate that there could be a direct link between migraines and behavioral disorders.”

Pakalnis added, “Our new data suggests a significant increase of oppositional defiant disorder in children with migraines. Children with [the behavioral disorder] have difficulty accepting parental rules or discipline, are often argumentative and, at times, have difficulty relating to siblings or peers. Understanding this relationship between behavioral disorders and migraines will help develop better treatment options and enable healthcare providers to better counsel the parents of the migraine sufferers.”

As part of ongoing research, a 3-month follow-up survey was conducted that suggests children with both conditions have similar headache outcomes as children without behavioral problems.

Pakalnis suggests parents track the frequency of headaches to see if behavioral problems relate to headache episodes. If the headaches occur more than 3 times a month, they should be treated aggressively. “In the future, we hope to examine the correlation between chronic daily headaches and behavioral issues,” said Pakalnis. “We’d also like to determine if depression and anxiety are higher in children with migraines. We already know this to be true with adults.”