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Margari F, Lucarelli E, Craig F, Petruzzelli MG, Lecce PA, Margari L. Psychopathology in children and adolescents with primary headaches: categorical and dimensional approaches. Cephalalgia 2013; 33:1311-8. [PMID: 23827982 DOI: 10.1177/0333102413495966] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Recurrent headache is common in childhood, but there is not a great amount of data on the associations between headaches and psychopathology in children. OBJECTIVE The aim of this study is to examine the relationships between primary headaches and psychopathology in children, using both the categorical and dimensional assessment. METHODS The sample consisted of 70 patients with primary headache compared to a matched sample of 50 healthy children. Psychiatric comorbidity was defined according to the diagnostic criteria of the Diagnostic and Statistical Manual of Disorders. Child psychopathology outcomes were assessed using child- and parent-reported standardized instruments. RESULTS Internalizing and externalizing problems were significantly represented among children with headaches compared to the control group, respectively 63% and 27%, without significant differences between migraine and tension-type headache children. Moreover, a total of 26% of the children with a headache reported psychiatric comorbidity such as anxiety and mood disorders. CONCLUSION The dimensional approach improves accuracy in the recognition of emotional and behavioral problems compared to the categorical approach; however, the use of both of these approaches could be useful for clinical practice, treatment and research.
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Affiliation(s)
- Francesco Margari
- Psychiatry Unit, Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs of the "Aldo Moro" University of Bari, Italy
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Pavone P, Rizzo R, Conti I, Verrotti A, Mistretta A, Falsaperla R, Pratico AD, Grosso G, Pavone L. Primary headaches in children: clinical findings on the association with other conditions. Int J Immunopathol Pharmacol 2013; 25:1083-91. [PMID: 23298498 DOI: 10.1177/039463201202500425] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of the present study is to report on the frequency of some comorbidities in primary headaches in childhood. Two hundred and eighty children (175 males and 105 females; ratio 1.7:1), aged 4 to 14 years, affected by primary headaches were consecutively enrolled in this study. In direct interviews, parents and children gave information about the association of their headaches with different conditions including asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight, affections some time associated in the literature to headache as comorbidities . In addition, anxiety and depression, attention deficit/hyperactivity disorder, tics, learning disabilities and obsessive-compulsive disorders, using psycho-diagnostic scales were evaluated. Two hundred and eighty children matched for age, sex, race and socio-economic status, were used as controls. No significant association of primary headaches was found with asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight. Overall behavioral disorders were more common in children who experienced headache than in controls. A significant association of primary headache was found with anxiety and depression (p value < 0.001), but not with the other psychiatric disorders. Primary headaches in children are not associated with most of the psychiatric and systemic conditions herein investigated. On the contrary, there was a significant association with anxiety and depression, as frequently reported in adults.
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Affiliation(s)
- P Pavone
- Department of Pediatrics and Pediatric Emergency, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy.
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Balottin U, Poli PF, Termine C, Molteni S, Spada G, Nappi G, Galli F. A meta-analysis of psychological factors in children with migraine and tension-type headache. J Headache Pain 2013. [PMCID: PMC3620340 DOI: 10.1186/1129-2377-14-s1-p20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Connelly M, Bickel J. Chronic daily headache in children and adolescents: science and conjecture. Pain Manag 2013; 3:47-58. [DOI: 10.2217/pmt.12.75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
SUMMARY Chronic daily headache comprises a group of headache disorders in which headaches occur almost daily or continuously over several months. Although chronic daily headache is one of the most common chronic pain disorders in pediatrics, data on pathophysiological mechanisms and relative efficacy of treatments remain sparse. In this review, we aim to provide contemporary information on classification, epidemiology, etiology and treatment of pediatric chronic daily headache based on extant empirical data when available, or general consensus in the field when not.
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Affiliation(s)
- Mark Connelly
- Children’s Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Jennifer Bickel
- Children’s Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64110, USA
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Balottin U, Fusar Poli P, Termine C, Molteni S, Galli F. Psychopathological symptoms in child and adolescent migraine and tension-type headache: A meta-analysis. Cephalalgia 2012. [DOI: 10.1177/0333102412468386] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction After decades of research, the importance of psychological factors in child and adolescent headache is no longer in doubt. However, it is not clearly understood whether different types of headache are comorbid with specific kinds of psychopathology. To address this issue, we set out to establish whether young patients with migraine do or do not show significant levels of psychopathological symptoms compared with age-matched healthy controls and patients with tension-type headache (TTH). Methods Ten studies were selected on the basis of a widely used psychodiagnostic tool (the Child Behavior Checklist (CBCL)) and by applying rigorous criteria: The studies were compared in a meta-analysis in order to evaluate the presence of Internalizing (mainly anxiety and depression) and Externalizing (mainly behavioral problems) symptoms in different types of headache (and versus healthy controls). Findings Patients with migraine showed more psychopathological symptoms than healthy controls. TTH patients also had more psychopathology than controls, although the difference was more marked in the area of Internalizing disorders. Finally, no differences emerged between migraine and TTH. Discussion and conclusion Psychopathological symptoms affect children with migraine, but also children with TTH. Biological, pathophysiological and clinical links need to be established. Effective treatment of affected children and adolescents is imperative in order to prevent chronic evolution. In this context, the CBCL may be a good screening instrument with a view to developing a tailored clinical approach.
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Affiliation(s)
- Umberto Balottin
- Department of Child Neurology and Psychiatry, ‘‘C. Mondino National Institute of Neurology’’ Foundation, IRCCS, Pavia, Italy
- Unit of Child Neurology and Psychiatry, Department of Public Health, Neuroscience, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Paolo Fusar Poli
- Department of Behavioural Health Sciences, University of Pavia, Italy
| | - Cristiano Termine
- Child Neuropsychiatry Unit, Department of Clinical and Biological Sciences, University of Insubria, Italy
| | - Silvia Molteni
- Unit of Child Neurology and Psychiatry, Department of Public Health, Neuroscience, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Federica Galli
- Headache Science Center, ‘‘C. Mondino National Institute of Neurology’’ Foundation, IRCCS, Pavia, Italy
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Arruda MA, Bigal ME. Behavioral and emotional symptoms and primary headaches in children: A population-based study. Cephalalgia 2012; 32:1093-100. [DOI: 10.1177/0333102412454226] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate behavioral and emotional symptoms in a community-based sample of children as a function of headache status and of headache frequency. Methods: Our sample consisted of 1,856 children (5–11 years). Primary headaches were assessed using a validated headache questionnaire. Emotional symptoms were assessed by the Child Behavior Checklist (CBCL). CBCL scores were modeled as a function of headache status after adjustments for demographics and headache frequency. Results: Relative to controls, children with migraine were significantly more likely to have abnormalities in the following CBCL domains: somatic, anxiety-depressive, social, attention, internalizing and total score. Children with tension-type headache (TTH) were significantly different from controls in the same domains but at a lower rate than migraine. In children with migraine, impairments significantly varied as a function of headache frequency, race, and income. In children with TTH, gender, age, and headache frequency were significantly associated with abnormal scores. Conclusions: Migraine and TTH are significantly associated with behavioral symptoms in several domains, and headache frequency affects the association. Internalizing symptoms are common in children with headaches, while externalizing symptoms (e.g. rule-breaking and aggressivity) are not significantly more common than in controls.
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Affiliation(s)
| | - Marcelo E Bigal
- Global Center for Scientific Affairs, Merck Inc., USA
- Department of Neurology, Albert Einstein College of Medicine, USA
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Masruha MR, Lin J, Minett TSC, Vitalle MSDS, Fisberg M, Vilanova LCP, Peres MFP. Social anxiety score is high in adolescents with chronic migraine. Pediatr Int 2012; 54:393-6. [PMID: 22212520 DOI: 10.1111/j.1442-200x.2011.03555.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Social anxiety disorder, also known as social phobia, is a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. It usually begins in mid-adolescence and has a chronic course and interferes in academic, social, family and personal functioning. Recent studies have shown that social anxiety disorder is more prevalent in adults with migraine. Little evidence on this subject is available for the adolescent population. METHODS This study was performed between August 2009 and August 2010; all patients were recruited in schools, pediatric or neuropediatric facilities, and were submitted to a detailed headache questionnaire, which consisted of demographic and clinical data. To evaluate social anxiety, the Social Phobia Inventory was used. RESULTS A total of 151 subjects were evaluated: 50 had chronic migraine, 50 had episodic migraine and 51 were control subjects. In the chronic migraine group, the mean score in the Social Phobia Inventory was 18.5 ± 12.4, which was significantly higher than in the episodic migraine group (12.1 ± 8.1) and in the control group (13.8 ± 10.8; F(2131) = 4.8, P= 0.010). The mean score, however, was not significantly different between the control and episodic migraine groups. CONCLUSIONS Chronic migraine is strongly associated with high social anxiety score, regardless of demographic data and pain intensity. The total burden of migraine may be increased with social anxiety disorder comorbidity.
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Affiliation(s)
- Marcelo R Masruha
- Department of Neurology, Federal University of São Paulo, São Paulo, Brazil.
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Arruda MA, Bigal ME. Migraine and behavior in children: influence of maternal headache frequency. J Headache Pain 2012; 13:395-400. [PMID: 22460944 PMCID: PMC3381068 DOI: 10.1007/s10194-012-0441-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 03/13/2012] [Indexed: 11/30/2022] Open
Abstract
We took advantage of a large population study in order to measure child behavior, as captured by the Child Behavior Checklist (CBCL) as a function of headache status in the children and their mothers. Of the target sample, consents and analyzable data were obtained from 1,856 families (85.4 %). Headache diagnoses were defined according to the second edition of the International Classification of Headache Disorders, and behavioral and emotional symptoms were assessed by the validated Brazilian version of the CBCL. We calculated the relative risk of abnormalities in the CBCL domains as a function of headache status in the children, after adjusting by a series of main effect models. Children with migraine were more likely to present abnormal scores in several of the CBCL scales, relative to children without migraine, and maternal migraine status contributed little to the model. However, when the mother had daily headaches, both children with and without migraine had similar CBCL scores. In multivariate analyses, migraine status in the children predicted CBCL scores (p < 0.01). Headache status and headache frequency in the mother did not predict CBCL scores in children with migraine but predicted in children without migraine (p < 0.01). The burden of migraine to the family is complex. Children with migraine are more likely to have behavioral and emotional symptoms than children without migraine. Children without migraine may be affected, in turn, by frequent headaches experienced by their mothers.
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Affiliation(s)
- Marco A Arruda
- Glia Institute, Av. Braz Olaia Acosta, 727, s. 310, CEP14026040, Ribeirão Preto, SP, Brazil.
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Siniatchkin M, Sendacki M, Moeller F, Wolff S, Jansen O, Siebner H, Stephani U. Abnormal Changes of Synaptic Excitability in Migraine with Aura. Cereb Cortex 2011; 22:2207-16. [DOI: 10.1093/cercor/bhr248] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Balottin U, Chiappedi M, Rossi M, Termine C, Nappi G. Childhood and adolescent migraine: A neuropsychiatric disorder? Med Hypotheses 2011; 76:778-81. [DOI: 10.1016/j.mehy.2011.02.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 01/18/2011] [Accepted: 02/06/2011] [Indexed: 11/15/2022]
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Approches psychologiques des céphalées chez l’enfant et l’adolescent. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)71037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Current world literature. Curr Opin Support Palliat Care 2011; 5:174-83. [PMID: 21521986 DOI: 10.1097/spc.0b013e3283473351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Antonaci F, Nappi G, Galli F, Manzoni GC, Calabresi P, Costa A. Migraine and psychiatric comorbidity: a review of clinical findings. J Headache Pain 2011; 12:115-25. [PMID: 21210177 PMCID: PMC3072482 DOI: 10.1007/s10194-010-0282-4] [Citation(s) in RCA: 256] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 12/16/2010] [Indexed: 01/23/2023] Open
Abstract
Migraine is an extremely common disorder. The underlying mechanisms of this chronic illness interspersed with acute symptoms appear to be increasingly complex. An important aspect of migraine heterogeneity is comorbidity with other neurological diseases, cardiovascular disorders, and psychiatric illnesses. Depressive disorders are among the leading causes of disability worldwide according to WHO estimation. In this review, we have mainly considered the findings from general population studies and studies on clinical samples, in adults and children, focusing on the association between migraine and psychiatric disorders (axis I of the DSM), carried over after the first classification of IHS (1988). Though not easily comparable due to differences in methodology to reach diagnosis, general population studies generally indicate an increased risk of affective and anxiety disorders in patients with migraine, compared to non-migrainous subjects. There would also be a trend towards an association of migraine with bipolar disorder, but not with substance abuse/dependence. With respect to migraine subtypes, comorbidity mainly involves migraine with aura. Patients suffering from migraine, however, show a decreased risk of developing affective and anxiety disorders compared to patients with daily chronic headache. It would also appear that psychiatric disorders prevail in patients with chronic headache and substance use than in patients with simple migraine. The mechanisms underlying migraine psychiatric comorbidity are presently poorly understood, but this topic remains a priority for future research. Psychiatric comorbidity indeed affects migraine evolution, may lead to chronic substance use, and may change treatment strategies, eventually modifying the outcome of this important disorder.
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Affiliation(s)
- Fabio Antonaci
- University Centre for Adaptive Disorders and Head pain (UCADH), Pavia, Italy.
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