Pediatric chronic daily headache associated with school phobia

Children and adolescents with school phobia sometimes complain of severe and persistent headaches that are diagnosed as chronic daily headache (CDH).We investigated 24 children with CDH and school phobia, and 26 children with CDH but without school phobia.Of 24 children with CDH and school phobia, 4% had chronic migraine (CM), 46% had chronic tension-type headache (CTTH) and 50% had both CTTH and migraine. However, of 26 children with CDH but without school phobia, 61% had CM, 24% had CTTH, 11% had CTTH and migraine, and 4% had new daily-persistent headache. There was a significantly higher rate of CTTH and both CTTH and migraine in children with CDH and school phobia than that in children with CDH but without school phobia (P < 0.0001). All of the 24 children with CDH and school phobia were found to have psychiatric disorders. Of 24 children, 71% were found to have adjustment disorders, 21% were found to have anxiety disorders, and 8% were found to have conversion disorder. Of 26 children with CDH but without school phobia, only 20% were found to have psychiatric disorders. There was a significantly higher rate of psychiatric disorders in children with CDH and school phobia than in children with CDH but without school phobia (P < 0.0001).Our study indicated that children with CDH and school phobia had problems in school and/or family and psychiatric disorders. They should be diagnosed and treated attentively not only for headaches but also for their psychosocial problems and psychiatric disorders.