Executive Function Among Children and Adolescents With Primary Headache

Abstract

Background

Headache is the most common neurologic symptom among children and adolescents, with a point prevalence of 58%. Headache disorders, particularly migraine, are considered one of the most disabling conditions in childhood. Headaches may cause cognitive impairment; however, research on this symptom—particularly on its influence on executive functioning—remains limited. We aimed to examine the executive function among children and adolescents with primary headache disorder compared to controls. Determining executive problems is important, as it allows us to ensure appropriate support and intervention.

Methods

This cross-sectional case-control study was performed at the Department of Pediatrics and Adolescents Medicine, Copenhagen University Hospital, Herlev, Denmark. A total of 109 pediatric patients diagnosed with primary headache were recruited from the pediatric outpatient clinic, along with 112 controls without a headache diagnosis. Executive function was assessed using selected subtests from the Delis-Kaplan Executive Function System (D-KEFS): the Trail Making Test, the Figure Design Test, and the Verbal Fluency Test.

Results

Among the patients, 31 were diagnosed with migraine, 31 with tension-type headache, 31 with mixed headache, and 16 with unclassified headache. A significance level of P <.05 was applied. Patients with headache performed significantly worse than controls on the Trail Making Test (P = .015). No statistically significant differences in executive function were observed between the migraine and tension-type headache subgroups.

Among children with migraine, higher headache frequency was associated with poorer performance on the Verbal Fluency Test–Switching condition (P = .04). In children with mixed headache, higher headache frequency was similarly associated with poorer performance on the Trail Making Test–number-letter switching (P = .037).

Conclusion

We found a significant difference between the patient and control group in one of the subtests, suggesting that headache could be associated with poorer executive function. Future studies are needed to examine the causality of this association.