{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:20:42Z","timestamp":1760059242813,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Federal Ministry of Education and Research","award":["01GY1615"],"award-info":[{"award-number":["01GY1615"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Tension-type headache and migraine are common among children and adolescents, often causing significant distress and persisting into adulthood. While outpatient pain therapy is essential, it is not always sufficient. To enhance initial therapy consultations, we evaluated a new educational website in a pediatric outpatient pain clinic. Methods: Ninety-three children with headache (Mage = 12.66, SDage = 2.86) visiting a specialized tertiary care center were randomly assigned to either an intervention or control group. The intervention group received immediate access to the website, while the control group was given access after the final assessment. Three online follow-up assessments occurred at four-week intervals after baseline. Recruitment occurred between April 2021 and October 2022. Results: Headache-related disability, headache days, and days with headache medication use significantly decreased over time (main effect; disability: \u03b2 = \u22120.23, 95%-CI = [\u22120.36; \u22120.09], p = 0.001; days: \u03b2 = \u22120.18, 95%-CI = [\u22120.32; 0.03], p = 0.018, medication: \u03b2 = \u22120.16, 95%-CI = [\u22120.31; \u22120.02], p = 0.026). No statistically significant changes were observed for average headache intensity, passive pain coping, positive self-instructions, seeking social support, pain self-efficacy, and headache-related knowledge. Groups did not differ in their improvement over time (interaction effect). Per-protocol analysis yielded a similar trend: headache-related disability improved significantly with no interaction effects. Despite the limited impact on headache management, children rated the website as relevant and easy to understand. Conclusions: While well-received, the website\u2019s effectiveness may have been limited by participants\u2019 prior knowledge, concurrent therapies, and low engagement. Future research should focus on better integrating the tool into treatment plans, optimizing usage, and tailoring content to varying knowledge levels. Nevertheless, it shows potential as a long-term self-management tool.<\/jats:p>","DOI":"10.3390\/children12060716","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T12:27:09Z","timestamp":1748867229000},"page":"716","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Complementary Effect of an Educational Website for Children and Adolescents with Primary Headaches in Tertiary Care: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"12","author":[{"given":"Henrike","family":"Goldstein","sequence":"first","affiliation":[{"name":"German Paediatric Pain Centre, Children\u2019s and Adolescents\u2019 Hospital Datteln, 45711 Datteln, Germany"},{"name":"Department of Children\u2019s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten\/Herdecke University, 58455 Witten, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5144-7166","authenticated-orcid":false,"given":"Lisa-Marie","family":"Rau","sequence":"additional","affiliation":[{"name":"German Paediatric Pain Centre, Children\u2019s and Adolescents\u2019 Hospital Datteln, 45711 Datteln, Germany"},{"name":"Department of Children\u2019s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten\/Herdecke University, 58455 Witten, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Verena","family":"Bachhausen","sequence":"additional","affiliation":[{"name":"German Paediatric Pain Centre, Children\u2019s and Adolescents\u2019 Hospital Datteln, 45711 Datteln, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4493-6356","authenticated-orcid":false,"given":"Julia","family":"Wager","sequence":"additional","affiliation":[{"name":"German Paediatric Pain Centre, Children\u2019s and Adolescents\u2019 Hospital Datteln, 45711 Datteln, Germany"},{"name":"Department of Children\u2019s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten\/Herdecke University, 58455 Witten, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1177\/0333102419837156","article-title":"The prevalence of headache in German pupils of different ages and school types","volume":"39","author":"Nieswand","year":"2019","journal-title":"Cephalalgia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1002\/ejp.1526","article-title":"Prevalence and associated psychosocial and health factors of chronic pain in adolescents: Differences by sex and age","volume":"24","author":"Wager","year":"2020","journal-title":"Eur. J. Pain"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s10194-023-01541-0","article-title":"Primary headache epidemiology in children and adolescents: A systematic review and meta-analysis","volume":"24","author":"Onofri","year":"2023","journal-title":"J. Headache Pain"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/0333102417738202","article-title":"The international classification of headache disorders, 3rd edition","volume":"38","year":"2018","journal-title":"Cephalalgia"},{"key":"ref_5","unstructured":"Ahmed, F., Bahra, A., Tyagi, A., and Weatherby, S. (2025, April 23). National Headache Management System for Adults. Available online: https:\/\/bash.org.uk\/wp-content\/uploads\/2023\/02\/01_BASHNationalHeadache_Management_SystemforAdults_2019_guideline_versi.pdf."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1111\/head.12394","article-title":"Headaches, quality of life, and academic performance in schoolchildren and adolescents","volume":"54","author":"Santos","year":"2014","journal-title":"Headache"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1111\/j.1526-4610.2011.01977.x","article-title":"Which patients with headache do not seek medical attention?","volume":"51","author":"Oliveira","year":"2011","journal-title":"Headache"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1002\/ejp.1661","article-title":"Factors associated with physician consultation and medication use in children and adolescents with chronic pain: A scoping review and original data","volume":"25","author":"Rosenthal","year":"2021","journal-title":"Eur. J. Pain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1177\/2042098614522683","article-title":"Medication overuse headache: Epidemiology, diagnosis and treatment","volume":"5","author":"Kristoffersen","year":"2014","journal-title":"Ther. Adv. Drug Saf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.jpain.2014.06.002","article-title":"The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States","volume":"15","author":"Groenewald","year":"2014","journal-title":"J. Pain"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1129-2377-15-15","article-title":"The evolution of headache from childhood to adulthood: A review of the literature","volume":"15","author":"Antonaci","year":"2014","journal-title":"J. Headache Pain"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Zernikow, B. (2014). Ambulante und Station\u00e4re Multimodale Schmerztherapie. Schmerztherapie bei Kindern und Jugendlichen und Jungen Erwachsenen, Springer.","DOI":"10.1007\/978-3-662-45057-4"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s00482-017-0215-0","article-title":"Therapy outcome one year after pediatric outpatient chronic pain evaluation: Chronic Pain Grading (CPG) for adolescent pain patients","volume":"31","author":"Stahlschmidt","year":"2017","journal-title":"Schmerz"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/j.ejpain.2011.03.001","article-title":"Specialized multimodal outpatient treatment for children with chronic pain: Treatment pathways and long-term outcome","volume":"15","author":"Hechler","year":"2011","journal-title":"Eur. J. Pain"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s00482-017-0245-7","article-title":"DreKiP\u2014Ein ambulantes Therapieprogramm f\u00fcr Kinder und Jugendliche mit Kopfschmerzen","volume":"32","author":"Richter","year":"2018","journal-title":"Schmerz"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1055\/a-1099-7325","article-title":"Mit Wissen zum Ziel: P\u00e4diatrische Schmerzedukation","volume":"3","author":"Wager","year":"2020","journal-title":"Der Schmerzpatient"},{"key":"ref_17","first-page":"46","article-title":"Schmerzedukation: Wichtige Aspekte f\u00fcr die Therapie","volume":"70","author":"Laekeman","year":"2018","journal-title":"Zeitschrift f\u00fcr Physiotherapeuten"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Pendl, D., Maitz, K., and Gasteiger-Klicpera, B. (2022). Auf der Suche nach Gesundheitsinformationen im Internet. MedienP\u00e4dagogik, 43\u201346.","DOI":"10.21240\/mpaed\/00\/2022.10.14.X"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e2127024","DOI":"10.1001\/jamanetworkopen.2021.27024","article-title":"Effectiveness of a psychosocial aftercare program for youth aged 8 to 17 years with severe chronic pain: A randomized clinical trial","volume":"4","author":"Dogan","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Goldstein, H., Rau, L.-M., Humberg, C., Bachhausen, V., Stahlschmidt, L., and Wager, J. (2025). Efficacy of an educational website on headaches in schoolchildren: A cluster-randomized controlled trial. Headache.","DOI":"10.1111\/head.14923"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.1212\/WNL.57.11.2034","article-title":"PedMIDAS: Development of a questionnaire to assess disability of migraines in children","volume":"57","author":"Hershey","year":"2001","journal-title":"Neurology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1177\/0333102413508240","article-title":"Comparing patient and parent recall of 90-day and 30-day migraine disability using elements of the PedMIDAS and an Internet headache diary","volume":"34","author":"Heyer","year":"2014","journal-title":"Cephalalgia"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1111\/j.1468-2982.2004.00757.x","article-title":"Development of a patient-based grading scale for PedMIDAS","volume":"24","author":"Hershey","year":"2004","journal-title":"Cephalalgia"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1037\/0022-0663.81.3.392","article-title":"The \"testing\" phenomenon: Not gone but nearly forgotten","volume":"81","author":"Glover","year":"1989","journal-title":"J. Educ. Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1037\/a0037559","article-title":"The effect of testing versus restudy on retention: A meta-analytic review of the testing effect","volume":"140","author":"Rowland","year":"2014","journal-title":"Psychol. Bull."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1016\/j.jpain.2023.01.007","article-title":"Development and validation of the Scale for Pain Self-Efficacy (SPaSE) in German and English languages for children and adolescents","volume":"24","author":"Stahlschmidt","year":"2023","journal-title":"J. Pain"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1007\/s00482-008-0621-4","article-title":"Pain-related coping strategies in children and adolescents with chronic pain: Validation of a German version of the paediatric pain coping inventory (PPCI revised)","volume":"22","author":"Hechler","year":"2008","journal-title":"Schmerz"},{"key":"ref_28","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Lawrence Earlbaum Associates."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: A practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. R. Stat. Soc. Ser. B (Methodol.)"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"van Buuren, S. (2018). Flexible Imputation of Missing Data, CRC Press Taylor & Francis Group. [2nd ed.].","DOI":"10.1201\/9780429492259"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Pinheiro, J.C., and Bates, D.M. (2000). Mixed-Effects Models in S and S-PLUS, Springer.","DOI":"10.1007\/978-1-4419-0318-1"},{"key":"ref_32","unstructured":"Lydersen, S. (2022). Adjustment for baseline value in longitudinal randomised trials. Tidsskr. Nor. Legeforen, 142."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jclinepi.2006.03.012","article-title":"Quality criteria were proposed for measurement properties of health status questionnaires","volume":"60","author":"Terwee","year":"2007","journal-title":"J. Clin. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"264","DOI":"10.3758\/s13428-020-01407-2","article-title":"t-Test and ANOVA for data with ceiling and\/or floor effects","volume":"53","author":"Liu","year":"2021","journal-title":"Behav. Res. Methods"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1111\/head.14392","article-title":"Digital headache self-management interventions for patients with a primary headache disorder: A systematic review of randomized controlled trials","volume":"62","author":"Noser","year":"2022","journal-title":"Headache"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1129-2377-15-12","article-title":"Headstrong intervention for pediatric migraine headache: A randomized clinical trial","volume":"15","author":"Rapoff","year":"2014","journal-title":"J. Headache Pain."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.brat.2009.09.004","article-title":"A randomized controlled trial of Internet-based self-help training for recurrent headache in childhood and adolescence","volume":"48","author":"Trautmann","year":"2010","journal-title":"Behav. Res. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Moubayed, A., Injadat, M., Shami, A., and Lutfiyya, H. (2018). Relationship Between Student Engagement and Performance in E-Learning Environment Using Association Rules. 2018 IEEE World Engineering Education Conference (Edunine), Proceedings of the 2018 IEEE World Engineering Education Conference (EDUNINE), Buenos Aires, 11\u201314 March 2018, IEEE.","DOI":"10.1109\/EDUNINE.2018.8451005"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1542\/peds.84.1.103","article-title":"Pediatric pain: The parents\u2019 role","volume":"16","author":"Dolgin","year":"1989","journal-title":"Pediatrician"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1016\/j.ncl.2019.07.009","article-title":"Pediatric migraine: An update","volume":"37","author":"Greene","year":"2019","journal-title":"Neurol. Clin."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1186\/s12913-016-1403-9","article-title":"Household income determines access to specialized pediatric chronic pain treatment in Germany","volume":"16","author":"Ruhe","year":"2016","journal-title":"BMC Health Serv. Res."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/6\/716\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:44:16Z","timestamp":1760031856000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/6\/716"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":41,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["children12060716"],"URL":"https:\/\/doi.org\/10.3390\/children12060716","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2025,5,30]]}}}