Children with migraine or tension-type headache are more likely to have behavioral and emotional problems than their peers, according to a new study from Brazil.

The more frequently a child experiences migraine or headache, the greater this connection is, researchers say, with the most common problems being social and attention issues as well as depression and anxiety.

Researchers evaluated 1,856 children ages 5 to 11, using a standard headache questionnaire and the Child Behavior Checklist (CBCL). Overall, children with migraine were the most likely to experience difficulties in several categories of the CBCL, including somatic, anxiety-depression, social, attention and internalizing, which refers to behaviors directed inward, such as eating too much or too little, cutting one’s self and abusing substances. In all, more than half of the young migraineurs exhibited internalizing behaviors, compared to 19% of the control group. Children with tension-type headaches experienced the same types of problems, but less so than migraineurs. Researchers also noted that in this study, a link was not found between headache and migraine and externalizing behaviors, such as rule-breaking and aggression.

This study was the first large community-based survey of its kind, but it confirmed the work of previous studies.

“As previously reported by others, we found that migraine was associated with social problems. The ‘social’ domain identifies difficulties in social engagement as well as infantilized behavior for the age, and this may be associated with important impact on the personal and social life,” said Marco Arruda, MD, lead author and director of the Glia Institute in Sao Paulo.

The results of the study are important clinically, the authors noted, and health care professionals should be aware of the findings so that they may properly address potential problems in their young patients. Joining Dr. Arruda in the study was Marcelo Bigal, MD, of Merck, Inc. and the Albert Einstein College of Medicine in New York.

The study appeared in the journal Cephalalgia last month.