Predictors of Headache/Migraine and the Use of Complementary Medicine in U.S. Children: A Population-Based Analysis of 2017 National Health Interview Survey Data

Abstract

Background:

This study set out to determine the prevalence and possible risk factors of headache and/or migraine in U.S. children, as well as the prevalence of complementary medicine use in this population.

Methods:

This is a secondary analysis of data from the 2017 U.S. National Health Interview Survey. Sociodemographic and clinical characteristics were compared between individuals with and without headaches. A backward stepwise procedure with a logistic regression statistic was used to test for potential predictors.

Results:

Six percent of children reported headaches and/or migraine within the past 12 months. Headaches were predicted by older age, female sex, non-Hispanic white ethnicity, and living in the southern United States. Inability to afford balanced meals and feeling sad or depressed in the past 6 months were also associated with higher odds of headache. A total of 19.2% of children with headaches reported using mind–body medicine, compared with 12.2% of children without headaches. Most frequently used therapy was yoga (57.2%), followed by spiritual meditation (31.1%) and mindfulness meditation (24.0%). The prevalence of visits to a complementary medicine practitioner or healer was 12.5%. Most frequently seen practitioners were chiropractors (62.1%), followed by naturopaths (21.2%), homeopaths (14.1%), and traditional healers (2.5%).

Conclusions:

The common use of complementary medicine among children suffering from headaches is worth noting. Understanding the motivation for using complementary medicine, as well as the choice of different forms of such therapy, may shed further light on the health-seeking behavior of this population.

Introduction

Headache/migraine is one of the most common health complaints in children and adolescents.¹ Due to different sampling strategies, prevalence estimates vary widely in different national samples. According to findings from the 2009 National Health and Nutrition Examination Survey (NHANES), as many as 17.1% of nearly 11,000 U.S. children, ages from 4 to 18 years, who were surveyed in 1999–2004 had experienced frequent or severe headaches (including migraine) in the preceding 12 months.² More recent data from the 2016–2017 National Survey of Children's Health suggest a 12-month prevalence rate closer to 3.3% among U.S. children ages 3–17 years.³ Recurrent headaches/migraine can negatively impact a child's life in several ways. Such consequences can include school absenteeism, decreased academic performance, impaired social interactions, and increased risk of comorbidity.⁴ Given the adverse impact of frequent headaches/migraine on a child's quality of life, early intervention should be considered a treatment priority.

The management of pediatric headache/migraine primarily consists of pharmacologic therapy and nonpharmacologic measures. Pharmacologic therapy is typically prescribed for the acute management of pain and other associated symptoms of headache/migraine, and in some cases may be prescribed for headache prophylaxis.⁵ Nonpharmacologic measures tend to focus on eliminating or managing the triggers of headache/migraine, as well as the factors that exacerbate these symptoms; including dietary (e.g., tyramine intake), environmental (e.g., excessive screen time), physical (e.g., poor sleep habits), and psychological (e.g., stress) factors.^5
–7

Complementary and integrative medicine (CIM) therapies may be used to manage the triggers of headache/migraine (i.e., as a nonpharmacologic measure) and/or the symptoms of the condition (i.e., as an adjunct or substitute to pharmacologic therapy). For adults, 37.6% of headache/migraine sufferers used CIM for various conditions. In contrast, CIM use specifically for headache/migraine was much less prevalent in adults (3.3%).⁸ However, mind–body therapies are among the most frequently used forms of CIM in children and adolescents,⁷ with as many as 14% of U.S. youth with recurrent headaches using these therapies.⁹ These mind–body therapies, including biofeedback, cognitive behavioral therapy, hypnosis, meditation, and relaxation training, may help relieve the symptoms of headache by dampening neural nociceptive substrates.¹⁰

A 2018 meta-analysis of 11 trials concluded that mindfulness meditation significantly reduces pain intensity and headache frequency.¹¹ Also meta-analyses on mindfulness-based stress reduction and yoga showed promising effects on pain intensity and frequencies of headache/migraine.^12,13

Despite the promising effects of mind–body therapies for headache/migraine, and the appeal of these therapies to parents and children (i.e., low risk of adverse events),⁷ there still remains a paucity of research exploring the use of these therapies in children with headache/migraine.

To address this knowledge gap, this study set out to (1) determine the prevalence of, and possible risk factors for, headache/migraine among U.S. children and adolescents; (2) ascertain the prevalence of mind–body medicine (MBM) use, and the predictors of use, among U.S. children and adolescents with headache/migraine; and (3) explore the use of CIM-oriented practitioners/healers by U.S. children and adolescents with headache/migraine.

Methods

Study design

This research is a secondary analysis of data from the 2017 U.S. National Health Interview Survey (NHIS).

Data source

The NHIS is a national survey conducted annually by the National Center for Health Statistics for the purposes of monitoring the health of the U.S. population. Multistage sampling techniques are used to generate a nationally representative sample.¹⁴ Further information regarding survey composition, sampling strategy, and administration of the NHIS is reported elsewhere.¹⁵

Data from the NHIS Family File and NHIS Sample Child File were used for the current analyses. The Sample Child File covered additional topics and asked more specific questions than those in the Family File. Questions about the sample child's health were answered by a knowledgeable adult (e.g., a parent or guardian). Population-based estimates were calculated using weights calibrated to the 2010 census-based population. To account for any sampling differences, data were weighted separately by several demographic factors.

The Research Ethics Review Board of the NCHS approved the NHIS data collection protocol on June 12, 2015 (protocol no. 2015-08). All participants provided informed consent.

Population

The 2017 Sample Child File contained data from 8845 interviews, from an eligible sample of 9601 children (ages between 0 and 17 years), representing a conditional response rate of 92.1% (8845/9601). Taking into consideration the family response rate of 65.7%, the unconditional response rate for the child sample was 60.6% (multiplying the conditional rate of 92.1% by the final family response rate of 65.7%).¹⁶

Measures

The 2017 NHIS collected data on health-related and sociodemographic characteristics, including age, sex, ethnicity, region, family status, education, income, health insurance coverage, mental health, and healthy eating, as well as data on the use of complementary medicine. The authors defined MBM use as utilization of any of the following modalities within the past 12 months: meditation (mantra/mindfulness/spiritual), guided imagery, progressive relaxation, yoga, Tai Chi, and qigong. A complementary medicine practitioner or healer visit was defined as use of any of the following providers in the previous 12 months: traditional healer, naturopathy practitioner, homeopathy practitioner, and chiropractor. Headaches were described as the presence of frequent or severe headaches, including migraines, within the past 12 months. This is in accordance with the original NHIS questions, which were either asked in Likert scale format or simply answered by “yes” or “no.” All questions were answered retrospectively. The wording of the questions for the main outcomes studied here can be found in Supplementary Table S4.

Statistical analyses

Prevalence and patterns of headaches among U.S. children were analyzed descriptively, as was the 12-month prevalence of MBM use among children with headaches/migraine. Results were reported as means and standard deviations, weighted frequencies and distributions, where eligible. Sociodemographic and health-related characteristics were compared between individuals with and without headaches using chi-squared tests. The same tests were used to compare the characteristics of children with headaches/migraine that either used or did not use MBM. Multiple logistic regression analyses were performed to identify independent predictors of MBM use and visits to complementary medicine-related practitioners in the past 12 months.

The following sociodemographic predictors were included in the logistic regression model: age (0–2, 3–6, 7–10, 11–13, and 14–17 years), sex (female, male), ethnicity (non-Hispanic white, Hispanic, African American, Asian, other), region (west, northeast, midwest, and south United States), educational status of mother and father (less than college, some college, or more), parent(s) present in the family (mother and father; mother, no father; father, no mother; neither mother nor father), health insurance status (private, Medicaid and other public, other coverage, uninsured), and family income (<U.S.$20,000; U.S.$20,000–U.S.$34,999; U.S.$35,000–U.S.$64,999; U.S.$65,000 or more). Past health-related factors (i.e., ability to afford healthy meals; current mental health) were tested as potential clinical predictors.

A backward stepwise procedure with a logistic regression statistic was used, with the p-value set at ≤0.05. Adjusted odds ratios with 95% confidence intervals were calculated. Statistical analyses were performed using the Statistical Package for Social Sciences software (IBM SPSS Statistics for Windows, release 25.0. Armonk, NY: IBM Corp.).

Results

A weighted total of 3,340,538 children (5.7%) reported having headache and/or migraine in the past 12 months. Based on univariate analyses, the proportion of children with headache/migraine was found to be significantly higher among those who were older, female, non-Hispanic white, living in the southern United States, had a mother but no father present at home, had Medicaid or other public health insurance, had a family income <US$65,000, sometimes or often could not afford balanced meals, and sometimes or often reported feeling unhappy/depressed/tearful in the past 6 months (Table 1).

Table 1.

Comparison of Characteristics Between Children With and Without Headache/Migraine

Characteristics	Children without headache/migraine (weighted n = 58,683,968)	Children with headache/migraine (weighted n = 3,340,538)	p
Age of the child			<0.001
0–2 years	N/R	N/R
3–6 years	16,239,590 (27.7%)	157,863 (4.7%)
7–10 years	15,868,270 (27.0%)	499,569 (15.0%)
11–13 years	11,712,265 (20.0%)	1,006,661 (30.1%)
1417 years	14,863,843 (25.3%)	1,676,445 (50.2%)
Sex of the child			0.001
Male	30,187,998 (51.4%)	1,428,570 (42.8%)
Female	28,495,970 (48.6%)	1,911,968 (57.2%)
Ethnicity			0.012
Non-Hispanic White	31,019,083 (52.9%)	1,901,336 (56.9%)
Hispanic	14,512,663 (24.7%)	797,981 (23.9%)
African American	8,846,925 (15.1%)	471,153 (14.1%)
Asian	3,559,304 (6.1%)	88,745 (2.7%)
Other	745,993 (1.3%)	81,323 (2.4%)
Region			0.086
West	14,194,845 (24.2%)	642,488 (19.2%)
Northeast	10,308,762 (17.6%)	603,010 (18.1%)
Midwest	12,662,316 (21.6%)	707,558 (21.2%)
South	21,518,045 (36.7%)	1,387,482 (41.5%)
Education, father			0.009
Less than college	14,988,911 (25.5%)	877,201 (26.3%)
Some college or more	27,760,032 (47.3%)	1,154,001 (34.5%)
Education, mother			0.963
Less than college	17,396,503 (29.7%)	987,176 (29.6%)
Some college or more	36,651,217 (62.5%)	2,098,821 (62.9%)
Parent(s) present in the family			<0.001
Mother and father	40,717,036 (69.4%)	1,951,642 (58.4%)
Mother, no father	13,591,877 (23.2%)	1,149,899 (34.4%)
Father, no mother	2,366,866 (4.0%)	105,436 (3.2%)
Neither mother nor father	2,008,189 (3.4%)	133,561 (4.0%)
Health insurance			0.007
Private	32,974,997 (56.2%)	1,598,056 (47.8%)
Medicaid and other public	20,523,369 (35.0%)	1,461,874 (43.8%)
Other coverage	1,819,969 (3.1%)	86,629 (2.6%)
Uninsured	3,095,523 (5.3%)	188,692 (5.6%)
Family income (USD)			<0.001
<$20,000	6,870,467 (11.7%)	500,830 (15.0%)
$20,000–$34,999	7,883,368 (13.4%)	549,053 (16.4%)
$35,000–$64,999	13,167,981 (22.4%)	900,556 (27.0%)
$65,000 or more	30,762,152 (52.4%)	1,390,099 (41.6%)
Could not afford balanced meals			<0.001
Never true	52,258,658 (89.1%)	2,585,262 (77.4%)
Sometimes true	4,785,138 (8.2%)	520,067 (15.6%)
Often true	1,640,172 (2.8%)	235,209 (7.0%)
Feeling unhappy/depressed/tearful in the past 6 months			<0.001
Never true	48,144,558 (82.0%)	2,359,819 (70.6%)
Sometimes true	4,490,601 (7.7%)	688,562 (20.6%)
Often true	1,485,072 (2.5%)	236,726 (7.1%)

Weighted frequencies are reported; p-values are derived from chi-squared tests.

All bold p-values are significant at 0.1 level.

N/R, no result.

When the sociodemographic and health-related variables were entered into a logistic regression model, the authors found older age (e.g., 14–17 years old; adjusted OR = 11.03; 95% CI = 5.47–22.23; p < 0.001), female sex (OR = 1.47; 95% CI = 1.12–1.92; p = 0.003), residing in the southern United States (OR = 1.61; 95% CI = 1.12–2.33; p = 0.011), sometimes being unable to afford healthy/balanced meals (OR = 2.14; 95% CI = 1.37–3.34; p = 0.001), and sometimes (OR = 2.52; 95% CI = 1.75–3.63; p < 0.001) or often (OR = 2.58; 95% CI = 1.40–4.74; p = 0.002) feeling unhappy/depressed/tearful within the past 6 months (Table 2) to be independent predictors of headache/migraine in the past 12 months (Table 2). By contrast, African American (OR = 0.47; 95% CI = 0.27–0.85; p = 0.011) and Asian (OR = 0.48; 95% CI = 0.24–0.95; p = 0.036) children had significantly lower odds of reporting headache/migraine.

Table 2.

Independent Predictors of Headache/Migraine in Children (n = 402)

Characteristics	Headache/migraine in the past 12 months
Characteristics	Adjusted OR (95% CI)	p
Age of the child		<0.001
0–2 years	N/R
3–6 years	Reference
7–10 years	3.50 (1.65–7.38)	0.001
11–13 years	8.78 (4.29–17.90)	<0.001
14–17 years	11.03 (5.47–22.23)	<0.001
Sex of the child		0.003
Male	Reference
Female	1.47 (1.12–1.92)	0.003
Ethnicity of child		0.022
Non-Hispanic white	Reference
Hispanic	0.84 (0.60–1.18)	0.305
African American	0.47 (0.27–0.85)	0.011
Asian	0.48 (0.24–0.95)	0.036
Other	1.50 (0.56–4.05)	0.419
Residence		0.018
West United States	Reference
Northeast United States	1.47 (0.96–2.25)	0.078
Midwest United States	1.02 (0.66–1.56)	0.943
South United States	1.61 (1.12–2.33)	0.011
Could not afford balanced meals		0.003
Never true	Reference
Sometimes true	2.14 (1.37–3.34)	0.001
Often true	1.37 (0.60–3.11)	0.258
Feeling unhappy/depressed/tearful in the past 6 months		<0.001
Never true	Reference
Sometimes true	2.52 (1.75–3.63)	<0.001
Often true	2.58 (1.40–4.74)	0.002

p-Values are derived from logistic regression analysis.

All bold p-values are significant at 0.1 level.

CI, confidence interval; N/R, no result; OR, odds ratio.

The prevalence of MBM use among children with headache/migraine was 19.2% (weighted total, n = 627,751), compared with 12.2% (weighted total n = 6,560,807) among children without headache/migraine. The most commonly used mind–body practice among children reporting headache/migraine was yoga (weighted total, n = 359,117; 57.2%), followed by spiritual meditation (weighted total, n = 232,522; 37.0%), mindfulness meditation (weighted total, n = 150,870; 24.0%), mantra meditation (weighted total, n = 133,676; 21.3%), progressive relaxation (weighted total, n = 73,553; 11.7%), and guided imagery (weighted total, n = 42,753; 6.8%). Neither Tai Chi nor qigong was reported to be used by children with headache/migraine.

The prevalence of MBM use was higher among older children and females (Supplementary Tables S1 and S2). Logistic regression analysis revealed two independent predictors of MBM use in children with headache/migraine: female sex (OR = 2.92; CI = 1.36–6.30, p = 0.006) and higher education level of the father (OR = 3.01; 95% CI = 1.38–6.60, p = 0.006) (Table 3). No other sociodemographic or health-related variable revealed statistical significance as an independent predictor.

Table 3.

Independent Predictors of Using Any Kind of Mind–Body Medicine in Children Suffering from Headache/Migraine (n = 402)

Characteristics	Using any kind of MBM in the past 12 months
Characteristics	Adjusted OR (95% CI)	p
Sex of the child		0.006
Male	Reference
Female	2.92 (1.36–6.30)
Education level of the father		0.006
Less than college	Reference
Some college or more	3.01 (1.38–6.60)

p-Values are derived from logistic regression analysis.

All bold p-values are significant at 0.1 level.

CI, confidence interval; MBM, mind–body medicine; OR, odds ratio.

A total of 12.5% (weighted n = 417,540) of children with headache/migraine visited a CIM-related practitioner or healer in the past 12 months, compared with 4.6% (weighted n = 2,483,346) of children without headache/migraine. Most frequently seen practitioners were chiropractors (weighted n = 259,295; 62.1%), followed by practitioners of naturopathy (weighted n = 88,685; 21.2%), practitioners of homeopathy (weighted n = 59,063; 14.1%), and traditional healers (weighted n = 10,497; 2.5%) (Supplementary Table S3). No independent predictors for visiting a CIM-related practitioner or healer were observed.

Discussion

This secondary analysis set out to address knowledge gaps regarding the utilization of MBM therapies and other CIM services among children and adolescents living with headache/migraine in the United States. The findings point to higher utilization rates of MBM therapies and other CIM services in this population, with yoga dominating as the therapy of choice. The analysis also revealed some important insights into the prevalence and predictors of headache/migraine in U.S. children and adolescents, of which a range of biopsychosocial determinants were found to be implicated.

The findings of this analysis indicate that 5.7% of U.S. children and adolescents experienced frequent or severe headache/migraine in the past 12 months. Considering the impact of headache/migraine on school performance, relationships, mental health, and quality of life,⁴ these children/adolescents may be living with considerable disease burden. In fact, headache disorders are ranked as the second leading cause of years lived with disability globally,¹⁷ with the greatest level of burden observed among young women.¹⁸ This is explained to some extent by the higher prevalence rates of headache/migraine among younger females, which is consistent with this analysis.

While the 12-month prevalence rate closely approximates that reported in the 2003 U.S. NHIS report (i.e., 6.7%)⁴ and in the 2016–2017 U.S. National Survey of Children's Health (i.e., 3.3%),³ it is somewhat lower than that identified in the 1999–2004 U.S. NHANES (i.e., 17.1%).² One potential explanation for this is that NHANES oversampled adolescents ages 12–19 years, which according to these analyses is an age-group associated with a higher prevalence of headache/migraine. Another consideration is that NHIS (e.g., 2013 and 2017) reported the prevalence of headache/migraine over a 1-year period, whereas the 1999–2004 NHANES reported a prevalence rate spanning three consecutive 2-year periods.²

A number of biopsychosocial factors were found to predict headache/migraine in U.S. children and adolescents. The higher prevalence of headache/migraine among female adolescents, relative to males and younger children, corroborates the findings of other analyses, as highlighted previously.¹⁸ Living in the southern United States was also associated with higher odds of experiencing headache/migraine. This is not surprising given the greater level of exposure to known risk factors of headache/migraine in the southern United States, including obesity, smoking, and socioeconomic stress (including intergenerational effects).^19,20

Another independent predictor of headache/migraine was the inability to afford healthy meals. While this may appear at first glance to be an indicator of socioeconomic stress (a known risk factor of headache/migraine),²⁰ neither family income nor health insurance status was shown to be significant independent predictors of this condition in the logistic regression model. An alternate explanation for this predictor is that it might serve as a proxy indicator of diet quality. Indeed, there is some, although low-quality, evidence to suggest that various dietary interventions may be effective for headache/migraine prophylaxis.²¹ Further investigation into the predictive effect of diet quality on risk of headache/migraine may shed some light on this association.

Depression is a well-recognized risk factor for physical morbidity,^22,23 including headache.²⁴ Supporting this, this analysis found “sometimes or often feeling unhappy/depressed/tearful” to be a significant predictor of headache/migraine in U.S. children and adolescents. While iatrogenic, biologic, and genetic determinants will play some part in this relationship, poor lifestyle behavior (e.g., low-quality diet, smoking, physical inactivity, alcohol consumption) is likely to be a strong mediating factor.²⁵ The extent to which these modifiable factors can collectively influence mood in children and adolescents, and in turn improve headache/migraine symptoms in this population, warrants further exploration to better understand the clinical implications of this finding.

Although various biopsychosocial factors may be implicated in the pathogenesis of headache/migraine, the conventional management of this disorder tends to focus on pharmacologic therapy.²⁶ However, concerns regarding the safety of analgesic use in children/adolescents can often drive people to seek CIM treatments for headache/migraine, such as MBM techniques.²⁷ The results of this analysis support this claim, indicating that 1 in 9 children with headache/migraine (vs. 1 in 21 without headache/migraine) consult a CIM-oriented practitioner/healer, while 1 in 5 with headache/migraine (vs. 1 in 8 without headache/migraine) use some form of MBM (predominantly yoga and spiritual meditation).

The discrepancy between CIM service use and MBM use may suggest that children/adolescents and/or their parents choose to self-prescribe these MBM techniques, rather than seek advice from a practitioner. While it is possible that these therapies could have been recommended by a conventional health care provider, the paucity of high-quality evidence supporting these treatments for headache/migraine, and their general exclusion from clinical practice guidelines,^11,28,29 indicates this is probably unlikely.

Although there were no independent predictors of consulting a CIM-oriented practitioner/healer for headache/migraine, two factors were found to predict MBM use: female sex and having a father with a higher education. This finding is consistent with evidence from other epidemiologic studies, which demonstrate that users of CIM services are more likely to be female and to have a higher education.^30,31 This finding adds to this body of work, suggesting that in a pediatric population, parent education also may be correlated with CIM use—particularly MBM use. However, it is important to note that only the father's education, and not the mother's education, was found to predict MBM use in this population.

A possible explanation for this may relate to employment and income, which are also associated with CIM use,³⁰ with data from the U.S. Bureau of Labor Statistics (2018) reporting much higher labor force participation rates among men than women (i.e., 69% vs. 57%, respectively), suggesting that men may still be the main income earner in most U.S. households. All the same, it remains unclear why these predictors applied only to the use of MBM and not to other CIM treatments/services. Of course, this must also be considered against the background that this may only be a spurious correlation.

Limitations

Although this study furthers the understanding of the health care seeking behavior of children and adolescents with headache/migraine, the study does have some limitations. As this is a secondary analysis of existing data, biases inherent in the primary survey cannot be ruled out. For instance, the NHIS relies on self-reported data, and in the case of younger children, on proxy-reporting by parents. Therefore, design-related biases, such as misclassification or recall bias, may have been present. For example, the categories used in the NHIS for the individual forms of meditation are not formulated with sufficient separation. In some cases, there are strong overlaps. For instance, a program such as mindfulness-based stress reduction includes components of focused attention practice, mindfulness practice, and compassion practice.

Moreover, some terms such as “spiritual” meditation are not commonly used among experts in the field of CIM. Furthermore, the NHIS does not provide data for different headache types. Because the etiology and pathophysiology of each headache type are different, it is possible that the predictors and patterns of MBM therapy use could vary by headache type. It also should be taken into account that the NHIS did not specify whether the MBM therapies were used for headaches, or for other health-related conditions.

Conclusions

This study findings support previous research reporting headache/migraine as a serious health concern for U.S. children/adolescents. In addition to the more commonly known demographic risk factors of headache/migraine, such as older age and female sex, these findings suggest that negative lifestyle (e.g., low-quality meals) and poor mental health may also contribute to headache/migraine in children/adolescents. Furthermore, this study reveals that CIM treatments, particularly MBM, are sought after by a substantial portion of this population. Understanding the motivation for using MBM, and in particular the different forms of MBM, may shed further light on the health-seeking behavior of this population.

Public Health Relevance

Headache/migraine is a serious health concern for U.S. children/adolescents.

These findings suggest that a negative lifestyle and poor mental health may also contribute to headache/migraine in children/adolescents.

MBM therapies are sought after by a substantial portion of headache/migraine patients.

Understanding the motivation for using different forms of MBM may shed further light on the health-seeking behavior of this population.

Footnotes

Authors' Contributions

D.A. conceptualized and designed the article, conducted the statistical analysis, created the tables, drafted the initial article, and approved the final article as submitted. M.J.L., Y.Z., and H.C. contributed to the conceptualization and design of the article, drafted the initial article, reviewed and revised the article, and approved the final article as submitted.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

Supplementary Material

Supplementary Table S1

Supplementary Table S2

Supplementary Table S3

Supplementary Table S4

References

Bellini

, Arruda

, Cescut

, et al. Headache and comorbidity in children and adolescents. J Headache Pain, 2013; 14:79.

Lateef

, Merikangas

, He

, et al. Headache in a national sample of American children: Prevalence and comorbidity. J Child Neurol, 2009; 24:536–543.

Data Resource Center for Child and Adolescent Health. Data query from 2016 and 2016-2017 Combined National Survey of Children's Health Interactive Data Query, 2019. Online document at: http://childhealthdata.org/browse/survey accessed September 12, 2019 .

Strine

, Okoro

, McGuire

, et al. The associations among childhood headaches, emotional and behavioral difficulties, and health care use. Pediatrics, 2006; 117:1728–1735.

Teleanu

, Vladacenco

, Teleanu

, et al. Treatment of pediatric migraine: A review. Maedica (Buchar), 2016; 11:136–143.

Kacperski

, Kabbouche

, O'Brien

, et al. The optimal management of headaches in children and adolescents. Ther Adv Neurol Disord, 2016; 9:53–68.

Kemper

, Vohra

, Walls

. The use of complementary and alternative medicine in pediatrics. Pediatrics, 2008; 122:1374–1386.

Zhang

, Dennis

, Leach

, et al. Complementary and alternative medicine use among US adults with headache or migraine: Results from the 2012 National Health Interview Survey. Headache, 2017; 57:1228–1242.

Bethell

, Kemper

, Gombojav

, et al. Complementary and conventional medicine use among youth with recurrent headaches. Pediatrics, 2013; 132:e1173–e1183.

10.

Sierpina

, Astin

, Giordano

. Mind-body therapies for headache. Am Fam Physician, 2007; 76:1518–1522.

11.

, Hou

, Fang

. Mindfulness meditation for primary headache pain: A meta-analysis. Chin Med J (Engl), 2018; 131:829–838.

12.

Anheyer

, Leach

, Klose

, et al. Mindfulness-based stress reduction for treating chronic headache: A systematic review and meta-analysis. Cephalalgia, 2019; 39:544–555.

13.

Anheyer

, Klose

, Lauche

, et al. Yoga for treating headaches: A systematic review and meta-analysis. J Gen Intern Med, 2020; 35:846–854.

14.

National Center for Health Statistics

NCHS

. General Information, 2019. Online document at: https://www.cdc.gov/nchs/nchs_for_you/researchers.htm accessed September 12, 2019 .

15.

Centers for Disease Control and Prevention

CDC.

About the National Health Interview Survey, 2019. Online document at: www.cdc.gov/nchs/nhis/about_nhis.htm accessed September 12, 2019 .

16.

National Center for Health Statistics

NCHS

. National Health Interview Survey (NHIS) Public Use Data Release Survey Description, 2018. Online document at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2017/srvydesc.pdf accessed September 12, 2019 .

17.

Saylor

, Steiner

. The global burden of headache. Semin Neurol, 2018; 38:182–190.

18.

Collaborators Global Burden of Disease Study. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol, 2018; 17:954–976.

19.

Dwyer-Lindgren

, Bertozzi-Villa

, Stubbs

, et al. Inequalities in life expectancy among US counties, 1980 to 2014: Temporal trends and key drivers. JAMA Intern Med, 2017; 177:1003–1011.

20.

Stewart

, Roy

, Lipton

. Migraine prevalence, socioeconomic status, and social causation. Neurology, 2013; 81:948–955.

21.

Orr

. Diet and nutraceutical interventions for headache management: A review of the evidence. Cephalalgia, 2016; 36:1112–1133.

22.

Dhar

, Barton

. Depression and the link with cardiovascular disease. Front Psychiatry, 2016; 7:33.

23.

Moulton

, Pickup

, Ismail

. The link between depression and diabetes: The search for shared mechanisms. Lancet Diabetes Endocrinol, 2015; 3:461–471.

24.

Syed

, Mullick

MSI

, Hannan

. Psychiatric co-morbidity among patients with primary headache. Bang J Psychiatry, 2016; 30:32–35.

25.

Penninx

. Depression and cardiovascular disease: Epidemiological evidence on their linking mechanisms. Neurosci Biobehav Rev, 2017; 74(Pt B):277–286.

26.

Gilmore

, Michael

. Treatment of acute migraine headache. Am Fam Physician, 2011; 83:271–280.

27.

Hartling

, Ali

, Dryden

, et al. How safe are common analgesics for the treatment of acute pain for children? A systematic review. Pain Res Manag, 2016; 2016:5346819.

28.

Kim

. Effects of yoga exercises for headaches: A systematic review of randomized controlled trials. J Phys Ther Sci, 2015; 27:2377–2380.

29.

Millstine

, Chen

, Bauer

. Complementary and integrative medicine in the management of headache. BMJ, 2017; 357:j1805.

30.

Leach

. Profiling the Australian consumer of complementary and alternative medicine: A secondary analysis of National Health Survey data. Altern Ther Health Med, 2016; 22:64–72.

31.

Rhee

, Harris

. Reasons for and perceived benefits of utilizing complementary and alternative medicine in U.S. adults with migraines/severe headaches. Complement Ther Clin Pract, 2018; 30:44–49.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB

0.01 MB