Published online October 1, 2004
PEDIATRICS Vol. 114 No. 4 October 2004, pp. 981-987 (doi:10.1542/peds.2003-1103-L)
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Externalizing Problem Behaviors and Headache: A Follow-up Study of Adolescent Finnish Twins

Ruut Virtanen, MD*, Minna Aromaa, MD, PhD*, Markku Koskenvuo, MD, PhD*, Matti Sillanpää, MD, PhD*,{ddagger}, Lea Pulkkinen, PhD§, Liisa Metsähonkala, MD, PhD{ddagger}, Sakari Suominen, MD, PhD*, Richard J. Rose, PhD||, Hans Helenius, MSc and Jaakko Kaprio, MD, PhD#

* Department of Public Health, University of Turku, Turku, Finland
{ddagger} Department of Paediatric Neurology, University of Turku, Turku, Finland
§ Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
|| Department of Psychology, Indiana University, Bloomington, Indiana
Department of Biostatistics, University of Turku, Turku, Finland
# Department of Public Health, University of Helsinki and National Public Health Institute, Helsinki, Finland

Objective.To examine the association of teacher- and parent-rated behavior with headache in a prospective follow-up study of adolescent Finnish twins.

Methods.Questionnaire data were collected during 1995–2001 from a nationwide sample of Finnish families of 11-year-old twins who were born 1983–1987 (n = 5393) and again at age of 14. Psychological factors were measured by using parents’ and teachers’ ratings of a 37-item multidimensional rating instrument at the ages of 11 and 14.

Results.At age 11, headache frequency (5 categories) was associated with total scales of externalizing and internalizing problem behaviors and adaptive behaviors, assessed by parents, but only with externalizing problem behaviors assessed by teachers. Results were similar at age 14. The incidence of at least monthly headache between the ages of 11 and 14 years was predicted by externalizing problem behaviors and 2 subscales of adaptive behaviors: constructiveness and poor compliance. In twin pairs discordant for headache, externalizing and internalizing problem behaviors were more common among headache sufferers than among headache-nonsufferers. Headache-discordant monozygotic co-twins confirmed the association of externalizing problem behaviors with headache.

Conclusions.The frequency of adolescents’ headache is predicted by psychological factors, especially by externalizing problem behaviors. This seems to be independent of genetic or familial influences on behavior and headache. Behavioral problems may be a sign of worsening of headache or vice versa.

Key Words: child • headache • behavior

Abbreviations: MPNI, Multidimensional Peer Nomination Inventory • MZ, monozygotic • DZ, dizygotic • Tr-MPNI, Teacher Rating Form • Pr-MPNI, Parent Rating Form • OR, odds ratios • CI, confidence interval • CBCL, Child Behavior Checklist

Accepted Apr 1, 2004.


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