Investigators at Istanbul University and Mersin University School of Medicine, Turkey, assessed the occurrence, prevalence and clinical characteristics of primary headache in pediatric patients, aged <16 years, with chronic rheumatic diseases such as juvenile idiopathic arthritis (JIA) and familial Mediterranean fever (FMF). A 53-item headache questionnaire was completed by 601 patients (378 with FMF and 223 with JIA). Each group was divided into two subgroups according to headache occurrence or nonoccurrence: 29.5% with FMF had migraine, 37.6% probable migraine and 32.9% with tension type headache (TTH). In JIA group, 28.2% had migraine, 41.2% probable migraine, and 30.6% with TTH. Headaches were not aggravated by exacerbation periods of the systemic disease. Family history of hypertension and diabetes and of headache was reported higher in patients with headache, especially migraineurs. 
COMMENTARY. Theories of mechanism of increased prevalence of headache, especially migraine, in children with chronic rheumatic disease, as proposed by the investigators, include rheumatic disease associated emotional stress, vascular headache triggered by immune mediated disease, and as part of the underlying rheumatic disease process. Headache should be a part of the history in patients with chronic rheumatic disease and, as shown in the following study, in their parents.
A previous study by investigators at Duke University, Durham, NC, examined the relationships of parental and family history on the pain experience of children with chronic rheumatic disease . More than 90% of parents of children seen in a pediatric rheumatology clinic described a personal pain history, including migraine headache. Parents who had treatment for their own pain had children with higher pain ratings. Gathering information from parents about their own pain histories, health care providers can identify children at risk for developing maladaptive pain coping strategies and higher levels of disease-related pain and disability. Parents should be included in interventions aimed at reducing children's pain and improving children's abilities to cope with pain.