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What can you tell me about headaches in younger children? We have a nine-year-old daughter who hasn't started her menses yet but has monthly (sometimes weekly) headaches. Is this normal?

Pain is never really "normal" and is a signal that should not be ignored. Though not "normal," research shows that chronic, persistent, recurring pain (daily, weekly, or monthly) is a common pattern among children. In fact, it has been suggested that one-third of all children around the world are experiencing pain of this type at any given point in time. A recent systematic review was performed by a group of researchers in Canada. A systematic review refers to a search (and analysis) of all published studies on this topic. Using predetermined criteria for what would qualify as a high-quality, appropriate study, the researchers sorted through 185 published papers from around the world. They ended up with 41 that could be included. Looking at the studies that are available, here's what they found. The first thing they noticed was the wide range of prevalence reported. For example, studies of headache in children showed a range from 23 to 51 per cent. That broad of a range was also reported for stomach pain, back pain, musculoskeletal pain, and pain from other sources (including multiple pains). Let's take a closer look at the data on headache. Tension headaches were reported much more often than migraines with an obvious increase starting in second grade. Children in families with low levels of education and children who attend daycare are more likely to develop headaches. There is a worldwide trend of increasing prevalence of headache over a long period of time. The reason(s) for this trend remain a mystery at the present time but are considered "worrisome" by experts who study pain and pain patterns. Future research is needed to further explore this finding. The authors of this review say we should realize that persistent (chronic) pain in children and teens is more of a problem than we realized and should be considered a major health concern. Studies of health must shift focus to include children in this area and look for ways to reduce risks. Treatment to intervene as early as possible should be established and results studied to look for evidence-based success. Studies across the developmental life cycles (children to adults) may help reduce the numbers of adults who end up with chronic pain problems. Better designed, higher-quality studies are needed to make this research relevant and accurate. The authors also suggest that understanding why girls suffer more pain than boys across the years should be a focus of future studies as well.

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