The present study investigated influences of stress coping strategies and activity of HPA axis on stress load in young girls with chronic headache (migraine or tension-type). Anxiety and depression were also measured. These psychopathological characteristics significantly contributed to stress load, whereas the activity of HPA axis had no contribution. A lack of seeking social support and destructive stress coping were identified as possible influencing factors.

Stress-related psychological and biological characteristics were used to classify young girls to predict girls with chronic headache. This was done by stepwise discriminant function analysis that included at each step biological and psychological characteristics of stress load and stress coping to identify the best predictive power which was evaluated by canonical correlation coefficients. At each step psychological stress load was significant. Lack of problem-solving and seeking social support were important. Also passive avoidance and destructive stress coping. The best classification quality was obtained, when depression and anxiety of the children were included in discriminant function. Hyperactivity of HPA axis did not play an important role.

ZUSAMMENFASSUNGChronische Kopfschmerzen bei Kindern und Jugendlichen sind ein häufiges Krankheitsbild, bei dem Stressfaktoren eine bedeutsame Rolle spielen. Aus der empirischen Literatur ergibt sich, dass die Stressbelastung der Jugendlichen erhöht ist, die Jugendlichen aber gleichzeitig nur über sehr eingeschränkte Fertigkeiten zur Bewältigung von Stresssituationen verfügen.In der vorliegenden Arbeit wurde in einer kontrollierten Querschnittsstudie überprüft, welche Unterschiede sich beim Vergleich von Mädchen mit chronischen Kopfschmerzen mit einer Kontrollgruppe bezüglich Stressbelastung und Stressbewältigung zeigen. Darüber hinaus wurden die psychopathologischen Merkmale Ängstlichkeit und Depressivität erhoben und ein biologischer Indikator für chronischen Stress (die Cortisol-Aufwachreaktion) gemessen.Mit multiplen linearen Regressionsanalysen wurde geprüft, welche Variablen die erlebte Stressbelastung beeinflussen.Es wurden insgesamt 148 Mädchen untersucht im Altersbereich zwischen 13 und 17 Jahren. Stressbelastung und Stressbewältigung wurden mit dem SSKJ 3–8 gemessen. Speichelproben zur Bestimmung von Cortisol wurden zu Hause nach dem Aufwachen gesammelt.Die Ergebnisse belegen eine höhere Stressbelastung der Mädchen mit Kopfschmerzen auf körperlicher und psychischer Ebene und eine größere Empfindlichkeit für die Wahrnehmung einer Situation als stressbezogen. Die Stressbewältigungsstrategien waren signifikant ungünstiger. Spezifisch für die Mädchen mit Kopfschmerzen fand sich eine erhöhte Cortisol-Sekretion nach dem Aufwachen. Als bedeutsame Einflussfaktoren für eine hohe psychologische Stressbelastung erwiesen sich die destruktive Stressverarbeitung sowie ein hohes Ausmaß an Ängstlichkeit und Depressivität. Bisher vorliegende Daten zur stressbezogenen Entstehung und Aufrechterhaltung von Kopfschmerzen bei Jugendlichen konnten bestätigt werden. Die Ergebnisse der Regressionsanalysen sprechen dafür, in der therapeutischen Praxis ein besonderes Augenmerk auf die Einbeziehung von Angst und Depression zu richten.

Chronic headache in adolescents is frequent, and stress may play an important role. The empirical literature suggests that stress load of headache sufferers is increased but stress coping is limited. The present study investigated in a controlled design differences between girls with chronic headache and controls in stress load and stress coping. Additionally psychopathological characteristics such as anxiety and depression were measured and a biological indicator for chronic stress (the cortisol awakening response) was obtained 148 girls were investigated. Stress load and stress coping was measured by validated German questionnaires. Saliva samples were collected at home after awakening. Girls with headache had a higher stress load and higher stress vulnerability, but significant deficits in stress coping. The cortisol awakening response was increased specifically for girls with headache. Physiological as well as psychological stress load could be significantly predicted by multiple linear regressions. Significant predictors were inadequate stress coping, anxiety and depression, but not hyperactivity of HPA axis. The results were integrated into the available literature and further discussed within a psychobiological model of chronic headache in adolescents.

Girls with chronic headache often suffer also from marked anxiety and depression. The present study used psychological and biological characteristics related to stress load and stress coping to predict anxiety and depression. This was done by regression analysis. Anxiety could be better explained than depression. Psychological and physiological stress load played a significant role, but not activity of HPA axis, although cortisol awakening response was heightened specifically for headache sufferers.

Objective: The present study aimed to examine the role of stress for the development and maintenance of anxiety and depression in young girls with chronic headache. Methods and Materials: The degree of depression and anxiety was studied in 148 young girls with either migraine or tension type headache. Physical and psychological stress load was measured by validated questionnaires. As a biological indicator of stress the cortisol awakening response was analyzed. Results: Multiple regression showed significant relationships between stress load and depression as well as anxiety. The predictive power of physical stress symptoms was larger for anxiety. Cortisol after awakening was significantly more correlated to anxiety than to depression. Conclusion: The stress load of young girls with chronic headache seems to be an important factor in explaining depression as well as anxiety symptoms of these young adolescents. The greater predictive power of physical stress symptoms for anxiety might be due to a focusing on bodily changes as a consequence of headache. Treatment programs for chronic headache should include specific interventions addressing stress coping with depression and anxiety.

Background: Chronic headache in children and adolescents is frequent and often associated with anxiety and depression. Objective: The present study investigated whether anxiety and depression are more pronounced in female adolescents with chronic headache than in those who do not have headaches and explored the role of stress symptoms and stress coping. Method: The sample consisted of 77 fifteen-year-old female adolescents with chronic headache and 72 girls who served as controls. Stress symptoms and stress coping were measured with the Stressverarbeitungsfragebogen fur Kinder und Jugendliche (Coping with Stress Questionnaire for Children and Adolescents), depression was assessed by the Depression Inventory for Children and Adolescents, and anxiety was measured by the State-Trait-Anxiety-Inventory for children. The cortisol awakening response was measured as a biological marker of stress. Results: Higher levels of depression as well as anxiety in the adolescents with chronic headache were found. The adolescents with headache showed more stress symptoms and at the same time were limited in their ability to cope with stress. They had also higher cortisol after awakening. Conclusion: Anxiety and depression may contribute to the occurrence and maintenance of headache in adolescents and interfere with adequate coping that would be necessary to overcome chronic stress, as indicated by cortisol.

Chronic headache in adolescents is frequent and often associated with anxiety and depression. The present study investigated, whether psychological and physical stress symptoms have an infl uence on the occurrence of anxiety and depression and what is the role of stress coping. The sample consisted of 77 15 years old girls with chronic headache and 72 girls, who served as controls. Stress symptoms and stress coping were measured with the Stressverarbeitungsfragebogen für Kinder und Jugendliche (Coping with Stress Questionnaire for Children and Adolescents), depression was assessed by the Depression Inventory for Children and Adolescents, anxiety by the State-Trait Anxiety Inventory for Children. Linear regression was used to analyze the relationship between stress factors and anxiety resp. depression. Physical stress symptoms were related to anxiety, but not to depression. Coping strategies of the depressed as well as the anxious children were characterized by stress reinforcing behaviors. The results point to focusing on physical symptoms in the anxious headache patients and to avoidance coping in the depressed children.