All correspondence concerning this article should be addressed to Mark Connelly, Co-Director, IntegrativePain Management, Developmental and Behavioral Sciences, Children’s Mercy Hospitals and Clinics,2401 Gillham Road, Kansas City, MO, 64108, USA. E-mail: mconnelly1@cmh.eduReceived December 14, 2010; revisions received February 24, 2011; accepted March 1, 2011Objective To determine through a daily process study whether alleged psychological and health behaviorheadache triggers reliably predict headache occurrence in children. Methods Twenty-five children aged 8–17years with primary headaches reported on their expectancies for headache triggers and then used electronicdiaries three times daily for 2 weeks to record headache occurrence, stressors, type and timing of food anddrink intake, sleep and wake times, and sleep quality. Hypotheses pertaining to the association of presumedheadache triggers and headache occurrence were evaluated using multilevel models. Results Only changes instress level reliably preceded the occurrence of a new headache episode. Nights in which a child had lessthan his/her typical sleep quantity also tended to predict headache occurrence. Consumption of certain foodand drink items was found to be protective. Conclusions Daily stressors seem to be a more reliable triggerof children’s headaches than diet or sleep factors.Key words children; electronic diary; headache; triggers.
