1
|
Bidirectional Relations Among Depression, Migraine, and Epilepsy: Do They Have an Impact on Their Response to Treatment? Curr Top Behav Neurosci 2021; 55:251-265. [PMID: 34964936 DOI: 10.1007/7854_2021_286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The evaluation and treatment of patients with epilepsy is not limited to the type of epilepsy, but it must incorporate the common comorbid neurologic, psychiatric, and medical disorders, as the latter can bare an impact on the course and response to treatment of the seizure disorder and vice versa. In this article we review the bidirectional relations among epilepsy and two of its most common comorbidities, mood disorders and migraine and examine the implications of these relations on the selection of therapies of these three disorders and their response to treatment. We also review the most salient common pathogenic mechanisms that may explain such relations.
Collapse
|
2
|
Amador RO, Gfrerer L, Hansdorfer MA, Colona MR, Tsui JM, Austen WG. The Relationship of Psychiatric Comorbidities and Their Impact on Trigger Site Deactivation Surgery for Headaches. Plast Reconstr Surg 2021; 148:1113-1119. [PMID: 34705787 DOI: 10.1097/prs.0000000000008428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients seeking trigger site deactivation surgery for headaches often have debilitating symptoms that can affect their functional and mental health. Although prior studies have shown a strong correlation between psychiatric variables and chronic headaches, their associations in patients undergoing surgery have not been fully elucidated. This study aims to analyze psychiatric comorbidities and their impact on patients undergoing trigger site deactivation surgery for headaches. METHODS One hundred forty-two patients were prospectively enrolled. Patients were asked to complete the Patient Health Questionnaire-2 and Migraine Headache Index surveys preoperatively and at 12 months postoperatively. Data on psychiatric comorbidities were collected by means of both survey and retrospective chart review. RESULTS Preoperatively, 38 percent of patients self-reported a diagnosis of depression, and 45 percent of patients met Patient Health Questionnaire-2 criteria for likely major depressive disorder (Patient Health Questionnaire-2 score of ≥3). Twenty-seven percent of patients reported a diagnosis of generalized anxiety disorder. Patients with depression and anxiety reported more severe headache symptoms at baseline. At 1 year postoperatively, patients with these conditions had successful surgical outcomes comparable to those of patients without these conditions. Patients also reported a significant decrease in their Patient Health Questionnaire-2 score, with 22 percent of patients meeting criteria suggestive of depression, compared to 45 percent preoperatively. CONCLUSIONS There is a high prevalence of depression and anxiety in patients undergoing trigger site deactivation surgery. Patients with these comorbid conditions achieve successful surgical outcomes comparable to those of the general surgical headache population. Furthermore, trigger site deactivation surgery is associated with a significant decrease in depressive symptoms.
Collapse
Affiliation(s)
- Ricardo O Amador
- From the Division of Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts General Hospital
| | - Lisa Gfrerer
- From the Division of Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts General Hospital
| | - Marek A Hansdorfer
- From the Division of Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts General Hospital
| | - Mia R Colona
- From the Division of Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts General Hospital
| | - Jane M Tsui
- From the Division of Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts General Hospital
| | - William G Austen
- From the Division of Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts General Hospital
| |
Collapse
|
3
|
Papetti L, Loro PAD, Tarantino S, Grazzi L, Guidetti V, Parisi P, Raieli V, Sciruicchio V, Termine C, Toldo I, Tozzi E, Verdecchia P, Carotenuto M, Battisti M, Celi A, D'Agnano D, Faedda N, Ferilli MA, Grillo G, Natalucci G, Onofri A, Pelizza MF, Ursitti F, Vasta M, Velardi M, Balestri M, Moavero R, Vigevano F, Valeriani M. I stay at home with headache. A survey to investigate how the lockdown for COVID-19 impacted on headache in Italian children. Cephalalgia 2020; 40:1459-1473. [PMID: 33146039 PMCID: PMC7684684 DOI: 10.1177/0333102420965139] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective The present Italian multicenter study aimed at investigating whether the course of primary headache disorders in children and adolescents was changed during the lockdown necessary to contain the COVID-19 emergency in Italy. Methods During the lockdown, we submitted an online questionnaire to patients already diagnosed with primary headache disorders. Questions explored the course of headache, daily habits, psychological factors related to COVID-19, general mood and school stress. Answers were transformed into data for statistical analysis. Through a bivariate analysis, the main variables affecting the subjective trend of headache, and intensity and frequency of the attacks were selected. The significant variables were then used for the multivariate analysis. Results We collected the answers of 707 patients. In the multivariate analysis, we found that reduction of school effort and anxiety was the main factor explaining the improvement in the subjective trend of headache and the intensity and frequency of the attacks (p < 0.001). The greater the severity of headache, the larger was the clinical improvement (p < 0.001). Disease duration was negatively associated with the improvement (p < 0.001). It is noteworthy that clinical improvement was independent of prophylaxis (p > 0.05), presence of chronic headache disorders (p > 0.05) and geographical area (p > 0.05). Conclusions Our study showed that lifestyle modification represents the main factor impacting the course of primary headache disorders in children and adolescents. In particular, reduction in school-related stress during the lockdown was the main factor explaining the general headache improvement in our population.
Collapse
Affiliation(s)
- Laura Papetti
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Samuela Tarantino
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Licia Grazzi
- Headache Center, Neuroalgology Department, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Vincenzo Guidetti
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Pasquale Parisi
- Child Neurology, Department of Neuroscience, Mental Health and Sense Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Unit - Ismep - ARNAS Civico, Palermo, Italy
| | - Vittorio Sciruicchio
- Children Epilepsy and EEG Center, PO, San Paolo ASL (Azienda Sanitaria Locale), Bari, Italy
| | - Cristiano Termine
- Department of Medicine and Surgery, University of Insubria and ASST dei Sette Laghi, Varese, Italy
| | - Irene Toldo
- Centro Cefalee per l'età Evolutiva, Dipartimento di Salute della Donna e del Bambino, Università degli Studi, Azienda Ospedaliera di Padova, Padova, Italy
| | - Elisabetta Tozzi
- Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Paola Verdecchia
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Marco Carotenuto
- Neuropsichiatria Infantile, Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Matteo Battisti
- Child Neurology, Department of Neuroscience, Mental Health and Sense Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Angela Celi
- Department of Medicine and Surgery, University of Insubria and ASST dei Sette Laghi, Varese, Italy
| | - Daniela D'Agnano
- Children Epilepsy and EEG Center, PO, San Paolo ASL (Azienda Sanitaria Locale), Bari, Italy
| | - Noemi Faedda
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Michela An Ferilli
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Grillo
- Child Neuropsychiatry Unit - Ismep - ARNAS Civico, Palermo, Italy
| | - Giulia Natalucci
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Agnese Onofri
- Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Maria Federica Pelizza
- Centro Cefalee per l'età Evolutiva, Dipartimento di Salute della Donna e del Bambino, Università degli Studi, Azienda Ospedaliera di Padova, Padova, Italy
| | - Fabiana Ursitti
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michelangelo Vasta
- Unità di Neuropsichiatroia Infantile, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy
| | - Margherita Velardi
- Child Neurology, Department of Neuroscience, Mental Health and Sense Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Martina Balestri
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Romina Moavero
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy.,Unità di Neuropsichiatroia Infantile, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy
| | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Massimiliano Valeriani
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| |
Collapse
|
4
|
Dresler T, Caratozzolo S, Guldolf K, Huhn JI, Loiacono C, Niiberg-Pikksööt T, Puma M, Sforza G, Tobia A, Ornello R, Serafini G. Understanding the nature of psychiatric comorbidity in migraine: a systematic review focused on interactions and treatment implications. J Headache Pain 2019; 20:51. [PMID: 31072313 PMCID: PMC6734261 DOI: 10.1186/s10194-019-0988-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/27/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Migraine is a highly prevalent and disabling neurological disorder which is commonly linked with a broad range of psychiatric comorbidities, especially among subjects with migraine with aura or chronic migraine. Defining the exact nature of the association between migraine and psychiatric disorders and bringing out the pathophysiological mechanisms underlying the comorbidity with psychiatric conditions are relevant issues in the clinical practice. METHODS A systematic review of the most relevant studies about migraine and psychiatric comorbidity was performed using "PubMed", "Scopus", and "ScienceDirect" electronic databases from 1 January 1998 to 15 July 2018. Overall, 178 studies met our inclusion criteria and were included in the current review. RESULTS According to the most relevant findings of our overview, the associations with psychiatric comorbidities are complex, with a bidirectional association of major depression and panic disorder with migraine. Importantly, optimizing the pharmacological and non-pharmacological treatment of either migraine or its psychiatric comorbidities might help clinicians to attenuate the burden of both these conditions. CONCLUSIONS The available data highlight the need for a comprehensive evaluation of psychiatric disorders in migraine in order to promote an integrated model of care and carefully address the burden and psychosocial impairment related to psychiatric comorbidities in migraine.
Collapse
Affiliation(s)
- Thomas Dresler
- Department of Psychiatry & Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - Salvatore Caratozzolo
- Neurology Unit - Neurological and Vision Sciences Department, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Kaat Guldolf
- Department of Neurology, University Hospital Brussels, Jette, Belgium
| | - Jana-Isabel Huhn
- Praxis Gendolla, Specialized care for Psychiatry, Neurology, Psychotherapy and Pain Therapy, Essen, Germany
| | - Carmela Loiacono
- Child Neuropsychiatry school, University of Palermo, Palermo, Italy
| | | | - Marta Puma
- Headache Centre & Neurocritical Care Unit, Department of Human Neurosciences, Sapienza - University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Giorgia Sforza
- Child Neurology Unit, Department of Neuroscience and Neurorehabilitation, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Tobia
- Child Neuropsychiatry Unit, ASL 3, Turin, Italy
| | - Raffaele Ornello
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy. .,IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | | |
Collapse
|
5
|
Kanner AM, Ribot R, Mazarati A. Bidirectional relations among common psychiatric and neurologic comorbidities and epilepsy: Do they have an impact on the course of the seizure disorder? Epilepsia Open 2018; 3:210-219. [PMID: 30564780 PMCID: PMC6293067 DOI: 10.1002/epi4.12278] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2018] [Indexed: 01/13/2023] Open
Abstract
The treatment of epilepsy is not limited to the achievement of a seizure‐free state. It must also incorporate the management of common psychiatric and neurologic comorbidities, affecting on average between 30 and 50% of patients with epilepsy, which have a significant impact on their lives at various levels, including quality of life and the prognosis of the seizure disorder. Mood and anxiety disorders are the most frequent psychiatric comorbidities, whereas stroke and migraine are among the more common neurologic comorbidities, migraine among the younger patients and stroke among the older patients. Not only do these psychiatric and neurologic comorbidities each have a bidirectional relation with epilepsy, but primary mood disorders have a bidirectional relation with these 2 neurologic disorders. Furthermore, depression and migraine have been each associated with a more severe epilepsy course, whereas depression has been associated with a more severe course of stroke and migraines. The purpose of this article is to review the clinical implications of the complex relations among epilepsy and these 3 comorbid disorders, and to identify any clinical and/or experimental evidence that may suggest that having more than one of these comorbid disorders may increase the risk of and course of epilepsy.
Collapse
Affiliation(s)
- Andres M Kanner
- Comprehensive Epilepsy Center and Epilepsy Division Department of Neurology Miller School of Medicine University of Miami Miami Florida U.S.A
| | - Ramses Ribot
- Comprehensive Epilepsy Center and Epilepsy Division Department of Neurology Miller School of Medicine University of Miami Miami Florida U.S.A
| | - Andrey Mazarati
- Department of Pediatrics and Children's Discovery and Innovation Institute D. Geffen School of Medicine at UCLA Los Angeles California U.S.A
| |
Collapse
|
6
|
Guidetti V, Faedda N, Siniatchkin M. Migraine in childhood: biobehavioural or psychosomatic disorder? J Headache Pain 2016; 17:82. [PMID: 27619362 PMCID: PMC5016316 DOI: 10.1186/s10194-016-0675-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 12/12/2022] Open
Abstract
It is well documented that headache is a multifactorial disorder which includes not only genetic, biological, medical and neuropsychological factor but also psychological and personality traits. The close relationship between stress and migraine attacks and the significant psychiatric comorbidities in migraine provide evidence of a “paradigm” of tight interaction between somatic and psychological aspects in paediatric migraine. In particular in younger children, an uncomfortable situation, a psychological problem or an emotional distress is rarely expressed directly but usually through physical symptoms. So migraine may be considered as a disorder of psychobiological adaptation in which genetic predisposition interplays with internal and/or external environmental influences such as psycho-emotional, climatic, hormonal, dietary or other factors.
Collapse
Affiliation(s)
- Vincenzo Guidetti
- Department of Pediatric and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli, 108, 00185, Rome, Italy.
| | - Noemi Faedda
- Department of Pediatric and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli, 108, 00185, Rome, Italy
| | - Michael Siniatchkin
- Department of Medical Psychology and Medical Sociology, Christian-Albrechts-University, Kiel, Germany
| |
Collapse
|
7
|
Cerutti R, Valastro C, Tarantino S, Valeriani M, Faedda N, Spensieri V, Guidetti V. Alexithymia and psychopathological symptoms in adolescent outpatients and mothers suffering from migraines: a case control study. J Headache Pain 2016; 17:39. [PMID: 27093870 PMCID: PMC4837193 DOI: 10.1186/s10194-016-0640-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/15/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Headache is a common disorder affecting a growing number of children and adolescents. In recent years, there has been an increase in scientific interest in exploring the relationship between migraine and emotional regulation, and in particular, the impact of emotional dysregulation on mental and physical health. The present study aims to explore the relationship between migraine and alexithymia among adolescents and their mothers as well as the impact of this association on mental health. An additional aim is to verify whether alexithymia may be a predictor of psychopathological symptoms in adolescents and mothers with migraines. METHODS A total of 212 subjects were involved in this study. The sample was divided into (a) Experimental Group (EG) consisting of 106 subjects (53 adolescents and 53 mothers) with a diagnosis of migraine according to International Classification of Headache Disorders (ICHD-3) and (b) Control Group (CG) including 106 subjects (53 adolescents and 53 mothers) without a diagnosis of migraine. All participants completed the Toronto Alexithymia Scale to assess alexithymia and the Symptom Checklist-90-R to assess psychopathological symptoms. RESULTS Higher rates of alexithymia were found in the adolescents and mothers of the EG in comparison to the adolescents and mothers of the CG. Furthermore, adolescents and mothers experiencing both migraine and alexithymia, demonstrated a higher risk of psychopathology. CONCLUSIONS Findings from this study provide evidence that the co-occurrence of migraine and alexithymia increases the risk of psychopathology for both adolescents and their mothers.
Collapse
Affiliation(s)
- Rita Cerutti
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, Rome, Italy
| | - Carmela Valastro
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, Rome, Italy
| | - Samuela Tarantino
- Headeache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S.Onofrio, 4, Rome, Italy
| | - Massimiliano Valeriani
- Headeache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S.Onofrio, 4, Rome, Italy
| | - Noemi Faedda
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli, 108-00185, Rome, Italy
| | - Valentina Spensieri
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, Rome, Italy
| | - Vincenzo Guidetti
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli, 108-00185, Rome, Italy.
| |
Collapse
|
8
|
Hartberg S, Clench-Aas J, Raanaas RK, Lundqvist C. Coping strategies among adolescents with chronic headache and mental health problems: a cross-sectional population-based study. SPRINGERPLUS 2015; 4:801. [PMID: 26702390 PMCID: PMC4688278 DOI: 10.1186/s40064-015-1599-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/08/2015] [Indexed: 12/05/2022]
Abstract
To examine prevalence of mental health problems among adolescents with chronic headache and compare internal and external coping strategies in young people with chronic headaches with and without mental health problems. This study is based on a cross-sectional survey undertaken in Akershus County in Norway. A total of 19,985 adolescents were included in the study, covering lower secondary and upper secondary students, aged 13-19 years. Chronic headache was measured with a single item question based on headache frequency. Mental health was assessed by using the strengths and difficulties questionnaire (SDQ). Internal and external coping strategies were assessed through seven options for answering the question: What do you do/what happens when you are burdened by painful thoughts and feelings? Adolescents with chronic headaches showed more frequent mental health problems overall (23 %) compared to those without chronic headache (6 %). Logistic regression analyses showed that those adolescents having both chronic headaches and comorbid mental health problems more frequently used internal coping strategies, such as keeping feelings inside (OR 2.05), using abusive substances (OR 1.79) and talking oneself out of problems (OR 1.55), compared to those without mental health problems. Groups with mental health problems, especially with chronic headache, less frequently used the external strategy of talking to others about their problem than controls (OR 0.7-0.8). Factor analyses revealed significant differences in profiles of coping strategies between groups. We suggest that attention should be paid towards the high risk group that has both chronic headaches and mental health problems and their tendency to use destructive internal coping strategies.
Collapse
Affiliation(s)
- Silje Hartberg
- />Department of Landscape Architecture and Spatial Planning, Norwegian University of Life Sciences, Aas, Norway
- />Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Jocelyne Clench-Aas
- />Division of Mental Health, Department of Health Surveillance and Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Ruth Kjærsti Raanaas
- />Department of Landscape Architecture and Spatial Planning, Norwegian University of Life Sciences, Aas, Norway
| | - Christofer Lundqvist
- />Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway
- />Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- />Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
| |
Collapse
|
9
|
Tarantino S, De Ranieri C, Dionisi C, Gagliardi V, Capuano A, Vigevano F, Gentile S, Valeriani M. Migraine equivalents and related symptoms, psychological profile and headache features: which relationship? J Headache Pain 2015; 16:536. [PMID: 26059348 PMCID: PMC4467804 DOI: 10.1186/s10194-015-0536-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/01/2015] [Indexed: 01/03/2023] Open
Abstract
Background Migraine equivalents are common clinical conditions in children suffering from headache. Very few studies dealt with the psychological profile of children/adolescents with migraine equivalents. Our main aim was to compare the psychological profile between migraine children with and without migraine equivalents. Moreover, as secondary aim, exclusively in children with migraine equivalents, we investigated the possible relationship between migraine attack frequency and intensity and psychological factors. Methods We enrolled 136 young migraineurs. They were divided in two groups (patients with and without migraine equivalents). The psychological profile was assessed by means of SAFA Anxiety and Somatization questionnaires. Results Migraine equivalents were present in 101 patients (74.3 %). Anxiety (p = 0.024) and somatization (p = 0.001) levels, but not hypochondria (p = 0.26), were higher in patients with migraine equivalents. In children with migraine equivalents, a low frequency of attacks was related to separation anxiety (p = 0.034). Conclusions Migraine equivalents patients tend to feel more fearful and to experience more shyness. This, together with the tendency to somatization, may lead them to become vigilant in attachment relationships with their caregivers.
Collapse
Affiliation(s)
- Samuela Tarantino
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesú, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy,
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Innamorati M, Pompili M, Erbuto D, Ricci F, Migliorati M, Lamis DA, Amore M, Girardi P, Martelletti P. Psychometric properties of the stagnation scale in medication overuse headache patients. J Headache Pain 2015; 16:1052. [PMID: 25971238 PMCID: PMC4429426 DOI: 10.1186/1129-2377-16-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/26/2014] [Indexed: 02/03/2023] Open
Abstract
Background Medication-overuse headache (MOH) is often comorbid with emotional disturbances, contributing to poorer outcomes. The aims of the present study were to assess the psychometric properties of the Stagnation Scale in a sample of MOH patients, and to compare two factor models: a three-factor model reported in previous studies and a proposed bi-factor model. Methods Consecutive adult outpatients (N = 310) admitted to the Regional Referral Headache Centre of the Sant’Andrea Hospital in Rome (Italy) were administered the Stagnation Scale and two questionnaires measuring depression and perceived disability. Results The original three-factor model demonstrated an adequate fit to the data (χ2101 = 238.70; p < 0.001; Root Mean Square Error of Approximation [RMSEA] = 0.07; 90% CI of RMSEA = 0.06 / 0.08; Comparative Fit Index [CFI] = 0.98; Weighted Root Mean Square Residual [WRMR] = 0.75). However, the bi-factor model had a comparable or even better fit, with a RMSEA of 0.05 (90% CI: 0.04 / 0.07), providing strong evidence for an absolute fit to the data (χ288 = 161.43; p < 0.001; RMSEA = 0.05; 90% CI of RMSEA = 0.04 / 0.07; CFI = 0.99; WRMR = 0.56). The stagnation general factor and all the group factors correlated significantly and positively with convergent measures. Conclusions There is support for the use of the Stagnation Scale in MOH patients, with the goal of better understanding the role of psychological factors in the evolution and course of the disorder.
Collapse
Affiliation(s)
- Marco Innamorati
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy,
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Blaauw BA, Dyb G, Hagen K, Holmen TL, Linde M, Wentzel-Larsen T, Zwart JA. The relationship of anxiety, depression and behavioral problems with recurrent headache in late adolescence – a Young-HUNT follow-up study. J Headache Pain 2015; 16:10. [PMID: 25595046 PMCID: PMC4405520 DOI: 10.1186/1129-2377-16-10] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/22/2014] [Indexed: 11/25/2022] Open
Abstract
Background The comorbidity of headache and psychiatric symptoms is a well-recognized clinical phenomenon, but there are only limited data regarding the temporal relationship between headache and symptoms of anxiety and depression as well as behavioral problems in adolescents. This study investigates the relationship of anxiety and depressive symptoms and behavioral problems at baseline with recurrent headache at follow-up four years later. Methods Within the Nord-Trøndelag Health Study (HUNT), including repeated population-based studies conducted in Norway, 2399 adolescents in junior high schools aged 12–16 years (77% of the invited) participated in Young-HUNT1 (1995–1997) and again at follow-up four years later, in Young-HUNT2 (2000–2001). The same comprehensive questionnaire that included assessment of symptoms of anxiety and depression and behavioral problems, i.e. conduct and attention difficulties was completed in both studies. In addition 1665 of the participants were interviewed about their headache complaints in Young-HUNT2. Results In adjusted multivariate analyses we found that higher scores of anxiety and depressive symptoms at baseline were associated with recurrent headache at follow-up four years later (OR: 1.6, 95% CI: 1.2-2.1, p = 0.001), evident for migraine (OR: 1.8, 95% CI: 1.2-2.7, p = 0.008) and non-classifiable headache (OR: 1.7, 95% CI: 1.0-2.8, p = 0.034), but not statistically significant for tension-type headache (OR: 1.4, 95% CI: 1.0-1.9, p = 0.053). Higher scores of anxiety and depressive symptoms at baseline were significantly associated with more frequent headache at follow-up (monthly vs. no recurrent headache OR: 1.8, 95% CI: 1.3-2.5, p = 0.001, weekly or daily vs. no recurrent headache OR: 1.9, 95% CI: 1.2-2.9, p = 0.005). Among adolescents without recurrent headache at baseline, higher scores for symptoms of anxiety and depression were associated with new onset migraine four years later (OR: 2.6, 95% CI: 1.1-4.8, p = 0.036). Higher scores of attention problems at baseline were associated with non-classifiable headache at follow-up (OR: 2.0, 95% CI: 1.3-3.4, p = 0.017). Conclusions Results from the present study showed that symptoms of anxiety and depression in early adolescence were associated with recurrent headache four years later. Recognizing anxiety and depressive symptoms should be considered part of the clinical assessment in young headache patients, as early identification of these associated factors may lead to improved headache management.
Collapse
Affiliation(s)
- Brit A Blaauw
- Department of Neurology, Vestfold Hospital, Tønsberg, Norway.
| | | | | | | | | | | | | |
Collapse
|
12
|
Psychiatric comorbidity of chronic daily headache: focus on traumatic experiences in childhood, post-traumatic stress disorder and suicidality. Curr Pain Headache Rep 2014; 18:405. [PMID: 24532229 DOI: 10.1007/s11916-014-0405-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The fifth edition of the Diagnostic and Statistic Manual (DSM-5) reclassified some mental disorders recently. Post-traumatic stress disorder (PTSD) is in a new section termed "trauma- and stressor-related disorder". Community-based studies have shown that PTSD is associated with a notably high suicidal risk. In addition to previous findings of comorbidity between chronic daily headache (CDH) and both depressive disorders and anxiety disorders, recent data suggest that frequency of childhood maltreatment, PTSD, and suicidality are also increased in CDH. CDH patients with migraine aura are especially at risk of suicidal ideation. Research suggests that migraine attack, aura, frequency, and chronicity may all be related to serotonergic dysfunction. Vulnerability to PTSD and suicidality are also linked to brain serotonin function, including polymorphisms in the serotonin transporter gene (5-HTTLPR). In the present review, we focus on recent advances in knowledge of traumatic experiences in childhood, PTSD, and suicidality in relation to migraine and CDH. We hypothesize that vulnerability to PTSD is associated with migraine attack, migraine aura, and CDH. We further postulate that these associations may explain some of the elevated suicidal risks among patients with migraine, migraine aura, and/or CDH. Field studies are required to support these hypotheses.
Collapse
|
13
|
Sehgal SA, Hassan M, Rashid S. Pharmacoinformatics elucidation of potential drug targets against migraine to target ion channel protein KCNK18. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:571-81. [PMID: 24899801 PMCID: PMC4038526 DOI: 10.2147/dddt.s63096] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Migraine, a complex debilitating neurological disorder is strongly associated with potassium channel subfamily K member 18 (KCNK18). Research has emphasized that high levels of KCNK18 may be responsible for improper functioning of neurotransmitters, resulting in neurological disorders like migraine. In the present study, a hybrid approach of molecular docking and virtual screening were followed by pharmacophore identification and structure modeling. Screening was performed using a two-dimensional similarity search against recommended migraine drugs, keeping in view the physicochemical properties of drugs. LigandScout tool was used for exploring pharmacophore properties and designing novel molecules. Here, we report the screening of four novel compounds that have showed maximum binding affinity against KCNK18, obtained through the ZINC database, and Drug and Drug-Like libraries. Docking studies revealed that Asp-46, Ile-324, Ile-44, Gly-118, Leu-338, Val-113, and Phe-41 are critical residues for receptor–ligand interaction. A virtual screening approach coupled with docking energies and druglikeness rules illustrated that ergotamine and PB-414901692 are potential inhibitor compounds for targeting KCNK18. We propose that selected compounds may be more potent than the previously listed drug analogs based on the binding energy values. Further analysis of these inhibitors through site-directed mutagenesis could be helpful for exploring the details of ligand-binding pockets. Overall, the findings of this study may be helpful for designing novel therapeutic targets to cure migraine.
Collapse
Affiliation(s)
- Sheikh Arslan Sehgal
- National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Mubashir Hassan
- National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Sajid Rashid
- National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
| |
Collapse
|
14
|
Bellini B, Arruda M, Cescut A, Saulle C, Persico A, Carotenuto M, Gatta M, Nacinovich R, Piazza FP, Termine C, Tozzi E, Lucchese F, Guidetti V. Headache and comorbidity in children and adolescents. J Headache Pain 2013; 14:79. [PMID: 24063537 PMCID: PMC3849985 DOI: 10.1186/1129-2377-14-79] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
Headache is one of the most common neurological symptom reported in childhood and adolescence, leading to high levels of school absences and being associated with several comorbid conditions, particularly in neurological, psychiatric and cardiovascular systems. Neurological and psychiatric disorders, that are associated with migraine, are mainly depression, anxiety disorders, epilepsy and sleep disorders, ADHD and Tourette syndrome. It also has been shown an association with atopic disease and cardiovascular disease, especially ischemic stroke and patent foramen ovale (PFO).
Collapse
Affiliation(s)
- Benedetta Bellini
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Via Dei Sabelli 108, Rome, Italy
| | | | - Alessandra Cescut
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Via Dei Sabelli 108, Rome, Italy
| | - Cosetta Saulle
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Via Dei Sabelli 108, Rome, Italy
| | | | | | | | | | | | | | | | - Franco Lucchese
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Guidetti
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Via Dei Sabelli 108, Rome, Italy
| |
Collapse
|
15
|
Crystal SC, Napchan U, Robbins MS. Diagnosis, Subtypes, Epidemiology, Progression, Prognosis, and Comorbidity of Tension-type Headache. Headache 2013. [DOI: 10.1002/9781118678961.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
16
|
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.
Collapse
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
| | | | | | | | | | | |
Collapse
|
17
|
Singh AK, Shukla R, Trivedi JK, Singh D. Association of psychiatric co-morbidity and efficacy of treatment in chronic daily headache in Indian population. J Neurosci Rural Pract 2013; 4:132-9. [PMID: 23914085 PMCID: PMC3724287 DOI: 10.4103/0976-3147.112736] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To study the prevalence of psychiatric co-morbidity in patients of chronic daily headache (CDH) and compare the efficacy of treatment between various type of headache associated with psychiatric co-morbidity. MATERIALS AND METHODS Prospective case control cohort study, 92 consecutive patients of CDH meeting eligibility criteria. The diagnosis of various subtypes of CDH was made according to the IHS criteria. Age, sex, educational, marital and socioeconomic status, matched controls were also selected. Patients were evaluated with the Mini International Neuropsychiatric Interview (MINI) scale at the time of enrolment and at 3 months. RESULTS CDH accounted for 28% of all headache patients. The mean age of presentation was 30.2 ± 10.3 years, male: Female ratio of 28:64 and mean duration of 4.56 ± 0.56 years. Chronic migraine (CM) accounted for 59 patients, chronic tension type headache (CTTH) 22 patients, new daily persistent headache (NDPH) 3 patients and miscellaneous 8 patients. Psychiatric co-morbidity was present in 53.3% patients with CDH, and was more common in CM (62.7%) as compared to CTTH (36.4%). Single psychiatric co-morbidity was seen in 26 patients, while 23 patients had multiple co-morbidity. Major depressive episode, anxiety disorder, agoraphobia and dysthymia were significant psychiatric co-morbidities. Patients with CM were treated with topiramate or divalproex sodium ER and CTTH were treated with amitriptyline. 55 patients came for follow up at 3 months, improvement in headache was seen in 29 patients. CONCLUSION Psychiatric co-morbidity was present in more than 50% patients with CDH and its presence along with a duration of ≥2 years was associated with a poor response to treatment.
Collapse
Affiliation(s)
- Ajai Kumar Singh
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, Uttar Pradesh, India
| | - Rakesh Shukla
- Department of Neurology, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George's Medical University), Lucknow, Uttar Pradesh, India
| | - Jitendra Kumar Trivedi
- Department of Psychiatry, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George's Medical University), Lucknow, Uttar Pradesh, India
| | - Deepti Singh
- Department of Psychiatry, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George's Medical University), Lucknow, Uttar Pradesh, India
| |
Collapse
|
18
|
Esposito M, Parisi L, Gallai B, Marotta R, Di Dona A, Lavano SM, Roccella M, Carotenuto M. Attachment styles in children affected by migraine without aura. Neuropsychiatr Dis Treat 2013; 9:1513-9. [PMID: 24124370 PMCID: PMC3794987 DOI: 10.2147/ndt.s52716] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In recent years, great attention has been given to the presence of psychological problems and psychiatric comorbidity that are also present in children affected by primary headaches. The relationship between pain and attachment has been identified, and it may be that pain perception may change in relation with specific attachment styles. The aim of the present study was to assess the prevalent attachment style and verify its putative relationship and correlation with the main characteristics of migraine attacks, in school-aged children affected by migraine without aura (MoA). MATERIALS AND METHODS The study population consisted of 219 children (103 males, 116 females) aged between 6 and 11 years (mean 8.96 ± 2.14 years), consecutively referred for MoA compared with 381 healthy controls (174 males, 207 females; mean age 9.01 ± 1.75 years) randomly selected from schools. All the children were classified according to the attachment typologies of the Italian modified version of the Separation Anxiety Test; monthly headache frequency and mean headache duration were assessed from daily headache diaries kept by all the children. Headache intensity was assessed on a visual analog scale. The chi-square test and t-test, where appropriate, were applied, and the Spearman rank correlation test was applied to explore the relationship between the types of attachment style and clinical aspects of MoA. RESULTS The MoA group showed a significantly higher prevalence of type A (avoidant) attachment (P<0.001) and a significantly lower prevalence of type B (secure) attachment (P<0.001) compared with the control group. Moreover, the Spearman rank correlation analysis showed a significant relationship between MoA characteristics and the attachment style of MoA children. CONCLUSION The main findings of the present study were the higher prevalence among MoA children of the avoidant attachment style (type A) and the significantly lower prevalence of the secure style attachment (type B) compared with the normal controls, suggesting that the study of psychiatric comorbidity in pediatric headache may be enriched by this new aspect of analysis.
Collapse
Affiliation(s)
- Maria Esposito
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Esposito M, Gallai B, Parisi L, Roccella M, Marotta R, Lavano SM, Gritti A, Mazzotta G, Carotenuto M. Maternal stress and childhood migraine: a new perspective on management. Neuropsychiatr Dis Treat 2013; 9:351-5. [PMID: 23493447 PMCID: PMC3593768 DOI: 10.2147/ndt.s42818] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Migraine without aura is a primary headache which is frequent and disabling in the developmental age group. No reports are available concerning the prevalence and impact of migraine in children on the degree of stress experienced by parents. The aim of this study was to evaluate the prevalence of maternal stress in a large pediatric sample of individuals affected by migraine without aura. METHODS The study population consisted of 218 children (112 boys, 106 girls) of mean age 8.32 ± 2.06 (range 6-13) years suffering from migraine without aura and a control group of 405 typical developing children (207 boys, 198 girls) of mean age 8.54 ± 2.47 years. Mothers of children in each group answered the Parent Stress Index-Short Form (PSI-SF) questionnaire to assess parental stress levels. RESULTS The two groups were matched for age (P = 0.262), gender (P = 0.983), and body mass index adjusted for age (P = 0.106). Mothers of children with migraine without aura reported higher mean PSI-SF scores related to the Parental Distress domain (P < 0.001), Dysfunctional Parent-Child Interaction domain (P < 0.001), Difficult Child subscale (P < 0.001), and Total Stress domain than mothers of controls (P < 0.001). No differences between the two groups were found for Defensive Responding subscale scores. CONCLUSION Our study may be the first to highlight the presence of high levels of stress in parents of children affected by migraine without aura.
Collapse
Affiliation(s)
- Maria Esposito
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical, and Preventive Medicine, Second University of Naples, Naples
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Tarantino S, De Ranieri C, Dionisi C, Citti M, Capuano A, Galli F, Guidetti V, Vigevano F, Gentile S, Presaghi F, Valeriani M. Clinical features, anger management and anxiety: a possible correlation in migraine children. J Headache Pain 2013; 14:39. [PMID: 23651123 PMCID: PMC3653764 DOI: 10.1186/1129-2377-14-39] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 05/07/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Psychological factors can increase severity and intensity of headaches. While great attention has been placed on the presence of anxiety and/or depression as a correlate to a high frequency of migraine attacks, very few studies have analyzed the management of frustration in children with headache. Aim of this study was to analyze the possible correlation between pediatric migraine severity (frequency and intensity of attacks) and the psychological profile, with particular attention to the anger management style. METHODS We studied 62 migraineurs (mean age 11.2 ± 2.1 years; 29 M and 33 F). Patients were divided into four groups according to the attack frequency (low, intermediate, high frequency, and chronic migraine). Pain intensity was rated on a 3-levels graduate scale (mild, moderate and severe pain). Psychological profile was assessed by Picture Frustration Study test for anger management and SAFA-A scale for anxiety. RESULTS We found a relationship between IA/OD index (tendency to inhibit anger expression) and both attack frequency (r = 0.328, p = 0.041) and intensity (r = 0.413, p = 0.010). When we analyzed the relationship between anxiety and the headache features, a negative and significant correlation emerged between separation anxiety (SAFA-A Se) and the frequency of attacks (r = -0.409, p = 0.006). In our patients, the tendency to express and emphasize the presence of the frustrating obstacle (EA/OD index) showed a positive correlation with anxiety level (“Total anxiety” scale: r = 0.345; p = 0.033). CONCLUSIONS Our results suggest that children suffering from severe migraine tend to inhibit their angry feelings. On the contrary, children with low migraine attack frequency express their anger and suffer from separation anxiety.
Collapse
Affiliation(s)
- Samuela Tarantino
- Division of Neurology, Headache Centre, Ospedale Pediatrico Bambino Gesú, IRCCS, Rome, Italy
| | - Cristiana De Ranieri
- Unit of Clinical Psychology Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Cecilia Dionisi
- Faculty of Medicine and Psychology, “La Sapienza” University of Rome, Rome, Italy
| | - Monica Citti
- Division of Neurology, Headache Centre, Ospedale Pediatrico Bambino Gesú, IRCCS, Rome, Italy
| | - Alessandro Capuano
- Division of Neurology, Headache Centre, Ospedale Pediatrico Bambino Gesú, IRCCS, Rome, Italy
| | - Federica Galli
- Headache Science Centre of the IRCCS “National Institute of Neurology C. Mondino” Foundation, Pavia, Italy
| | - Vincenzo Guidetti
- Faculty of Medicine and Psychology, “La Sapienza” University of Rome, Rome, Italy
| | - Federico Vigevano
- Division of Neurology, Headache Centre, Ospedale Pediatrico Bambino Gesú, IRCCS, Rome, Italy
| | - Simonetta Gentile
- Unit of Clinical Psychology Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Fabio Presaghi
- Faculty of Medicine and Psychology, “La Sapienza” University of Rome, Rome, Italy
| | - Massimiliano Valeriani
- Division of Neurology, Headache Centre, Ospedale Pediatrico Bambino Gesú, IRCCS, Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| |
Collapse
|
21
|
Heckman BD, Merrill JC, Anderson T. Race, psychiatric comorbidity, and headache characteristics in patients in headache subspecialty treatment clinics. ETHNICITY & HEALTH 2012; 18:34-52. [PMID: 22541025 DOI: 10.1080/13557858.2012.682219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This research examined how race, psychiatric comorbidity, and headache characteristics are inter-related in patients with severe headache disorders. DESIGN This study used a naturalistic cohort design and assessed 114 Black and 173 White patients receiving treatment in headache subspecialty clinics in Cincinnati, Cleveland, Columbus, and Toledo, OH. Face-to-face interviews yielded headache and psychiatric diagnoses; 30-day daily diaries collected data on headache frequency, severity, and disability; and self-administered surveys obtained data on headache management self-efficacy, headache locus of control, and quality of life. RESULTS Compared with Whites, Blacks reported more frequent and severe headaches, were more likely to be diagnosed with depressive disorders, and were more likely to be diagnosed with chronic headaches. White and Black patients diagnosed with both depression and anxiety reported the most frequent headache days per month and the lowest levels of life quality and headache management self-efficacy. CONCLUSIONS Additional research on race, psychiatric comorbidity, and headache characteristics is needed that can inform culturally contextualized interventions for persons with severe headache disorders.
Collapse
|
22
|
Prakash S, Golwala P. Phantom headache: pain-memory-emotion hypothesis for chronic daily headache? J Headache Pain 2011; 12:281-6. [PMID: 21479704 PMCID: PMC3094645 DOI: 10.1007/s10194-011-0307-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 01/25/2011] [Indexed: 11/12/2022] Open
Abstract
The neurobiology of chronic pain, including chronic daily headache (CDH) is not completely understood. “Pain memory” hypothesis is one of the mechanisms for phantom limb pain. We reviewed the literature to delineate a relation of “pain memory” for the development of CDH. There is a direct relation of pain to memory. Patients with poor memory have less chance to develop “pain memory”, hence less possibility to develop chronic pain. Progressive memory impairment may lead to decline in headache prevalence. A similar relation of pain is also noted with emotional or psychiatric symptoms. Literature review suggests that there is marked overlap in the neural network of pain to that of memory and emotions. We speculate that pain, memory, and emotions are interrelated in triangular pattern, and each of these three is related to other two in bidirectional pattern, i.e., stimulation of one of these will stimulate other symptoms/networks and vice versa (triangular theory for chronic pain). Longstanding or recurrent noxious stimuli will strengthen this interrelation, and this may be responsible for chronicity of pain. Reduction of both chronic pain and psychological symptoms by cognitive behavioral therapy or psychological interventions further suggests a bidirectional interrelation between pain and emotion. Longitudinal studies are warranted on the prevalence of headache and other painful conditions in patients with progressive memory impairment to delineate the relation of pain to memory. Interrelation of headache to emotional symptoms should also be explored.
Collapse
Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Medical College, SSG Hospital, O-19, Doctor's Quarter, Jail Road, Baroda, Gujarat, 390001, India.
| | | |
Collapse
|
23
|
Özge A, Termine C, Antonaci F, Natriashvili S, Guidetti V, Wöber-Bingöl Ç. Overview of diagnosis and management of paediatric headache. Part I: diagnosis. J Headache Pain 2011; 12:13-23. [PMID: 21359874 PMCID: PMC3056001 DOI: 10.1007/s10194-011-0297-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 11/25/2010] [Indexed: 11/05/2022] Open
Abstract
Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. Moreover, the possible role of psychological factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. Subjects who have any signs or symptoms of focal/progressive neurological disturbances should be investigated by neuroimaging techniques. The electroencephalogram and other neurophysiological examinations are of limited value in the routine evaluation of headaches. In a primary headache disorder, headache itself is the illness and headache is not attributed to any other disorder (e.g. migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalgias). In secondary headache disorders, headache is the symptom of identifiable structural, metabolic or other abnormality. Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated with severe vomiting and headache associated with straining. Thus, the differential diagnosis between primary and secondary headaches rests mainly on clinical criteria. A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment, bearing in mind that children with headache are more likely to experience psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms and this creates an important healthcare problem for their future life.
Collapse
Affiliation(s)
- Aynur Özge
- Department of Neurology, Mersin University School of Medicine, Mersin, Turkey
| | - Cristiano Termine
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Fabio Antonaci
- University Center for Adaptive Disorders and Headache (UCADH), Unit of Pavia, Pavia, Italy
| | - Sophia Natriashvili
- Department of Psychiatry of Childhood and Adolescence, Medical University of Vienna, Vienna, Austria
| | - Vincenzo Guidetti
- Department of Child and Adolescent Neuropsychiatry, University La Sapienza, Rome, Italy
| | - Çiçek Wöber-Bingöl
- Department of Psychiatry of Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| |
Collapse
|
24
|
Termine C, Özge A, Antonaci F, Natriashvili S, Guidetti V, Wöber-Bingöl Ç. Overview of diagnosis and management of paediatric headache. Part II: therapeutic management. J Headache Pain 2011; 12:25-34. [PMID: 21170567 PMCID: PMC3072476 DOI: 10.1007/s10194-010-0256-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 09/07/2010] [Indexed: 12/12/2022] Open
Abstract
A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment. In part 1 of this article (Özge et al. in J Headache Pain, 2010), we reviewed the diagnosis of headache in children and adolescents. In the present part, we will discuss therapeutic management of primary headaches. An appropriate management requires an individually tailored strategy giving due consideration to both non-pharmacological and pharmacological measures. Non-pharmacological treatments include relaxation training, biofeedback training, cognitive-behavioural therapy, different psychotherapeutic approaches or combinations of these treatments. The data supporting the effectiveness of these therapies are less clear-cut in children than in adults, but that is also true for the data supporting medical treatment. Management of migraine and TTH should include strategies relating to daily living activities, family relationships, school, friends and leisure time activities. In the pharmacological treatment age and gender of children, headache diagnosis, comorbidities and side effects of medication must be considered. The goal of symptomatic treatment should be a quick response with return to normal activity and without relapse. The drug should be taken as early as possible and in the appropriate dosage. Supplementary measures such as rest in a quiet, darkened room is recommended. Pharmaco-prophylaxis is only indicated if lifestyle modification and non-pharmacological prophylaxis alone are not effective. Although many prophylactic medications have been tried in paediatric migraine, there are only a few medications that have been studied in controlled trials. Multidisciplinary treatment is an effective strategy for children and adolescents with improvement of multiple outcome variants including frequency and severity of headache and school days missed because of headache. As a growing problem both children and families should be informed about medication overuse and the children's drug-taking should be checked.
Collapse
Affiliation(s)
- Cristiano Termine
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Como, Italy
| | - Aynur Özge
- Department of Neurology, Mersin University School of Medicine, Mersin, Turkey
| | - Fabio Antonaci
- Unit of Pavia, University Center for Adaptive Disorders and Headache (UCADH), Pavia, Italy
| | - Sophia Natriashvili
- Department of Psychiatry of Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Vincenzo Guidetti
- Department of Child and Adolescent Neuropsychiatry, University La Sapienza, Rome, Italy
| | - Çiçek Wöber-Bingöl
- Department of Psychiatry of Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| |
Collapse
|
25
|
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.
Collapse
Affiliation(s)
- Fabio Antonaci
- University Centre for Adaptive Disorders and Head pain (UCADH), Pavia, Italy.
| | | | | | | | | | | |
Collapse
|
26
|
|
27
|
Ortiz A, Cervantes P, Zlotnik G, van de Velde C, Slaney C, Garnham J, Turecki G, O'Donovan C, Alda M. Cross-prevalence of migraine and bipolar disorder. Bipolar Disord 2010; 12:397-403. [PMID: 20636637 DOI: 10.1111/j.1399-5618.2010.00832.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In two related studies, we explored the prevalence of migraine and its associated clinical characteristics in patients with bipolar disorder (BD) as well as psychiatric morbidity in patients treated for migraine. METHOD The first study included 323 subjects with BD type I (BD I) or BD type II (BD II), diagnosed using the Schedule for Affective Disorders and Schizophrenia, Lifetime version (SADS-L) format, or the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Migraine history was assessed by means of a structured questionnaire. In a second sample of 102 migraine patients, we investigated current and lifetime psychiatric morbidity using the SADS-L. Statistical analyses were conducted using nonparametric analysis and log-linear models. RESULTS A total of 24.5% of BD patients had comorbid migraine; those with BD II had a higher prevalence (34.8%) compared to BD I (19.1%) (p < 0.005). BD patients with comorbid migraine had significantly higher rates of suicidal behaviour, social phobia, panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder (all p < 0.05). In the sample of migraine patients, 34.3% had a current psychiatric diagnosis, and 73.5% had a lifetime psychiatric diagnosis. The prevalence of BD I was 4.9%, and 7.8% for BD II. DISCUSSION Migraine is prevalent within the BD population, particularly among BD II subjects. It is associated with an increased risk of suicidal behaviour and comorbid anxiety disorders. Conversely, migraine sufferers have high rates of current and lifetime psychopathology. A greater understanding of this comorbidity may contribute to our knowledge of the underlying mechanisms of BD.
Collapse
Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Pompili M, Serafini G, Di Cosimo D, Dominici G, Innamorati M, Lester D, Forte A, Girardi N, De Filippis S, Tatarelli R, Martelletti P. Psychiatric comorbidity and suicide risk in patients with chronic migraine. Neuropsychiatr Dis Treat 2010; 6:81-91. [PMID: 20396640 PMCID: PMC2854084 DOI: 10.2147/ndt.s8467] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to explore the impact of mental illness among patients with migraine. We performed MedLine and PsycINFO searches from 1980 to 2008. Research has systematically documented a strong bidirectional association between migraine and psychiatric disorders. The relationship between migraine and psychopathology has often been clinically discussed rather than systematically studied. Future research should include sound methodologically-based studies focusing on the interplay of factors behind the relationship between migraine, suicide risk, and mental illness.
Collapse
Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Sances G, Ghiotto N, Galli F, Guaschino E, Rezzani C, Guidetti V, Nappi G. Risk factors in medication-overuse headache: a 1-year follow-up study (care II protocol). Cephalalgia 2010; 30:329-36. [PMID: 19614697 DOI: 10.1111/j.1468-2982.2009.01934.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To investigate factors influencing prognosis in medication-overuse headache (MOH), we conducted a 12-month follow-up of patients with probable MOH. We recruited 215 patients consecutively admitted to our headache centre for an inpatient detoxification treatment. We analysed likely predictor factors for headache resolution (sex, age, primary headache, psychiatric comorbidity, type and timing of overuse). Mann-Whitney U-test and chi-squared test were used. One year after withdrawal, we had complete data on 172 patients (80%): 38 of these patients (22%) had relapsed into overuse and 134 (78%) had not. The negative prognostic factors for relapse were: intake of more than 30 doses/month (P = 0.004), smoking (P = 0.012), alcohol consumption (P = 0.037), non-confirmation of MOH diagnosis 2 months after detoxification (P = 0.000), and return to overused drug(s) (P = 0.000). The 1-year relapse rate was 22%. The existence of sub-groups of MOH patients with such risk factors could influence treatment strategies.
Collapse
Affiliation(s)
- G Sances
- Headache Unit & University Centre for Adaptive Disorders and Headache, University of Pavia, Pavia, Italy.
| | | | | | | | | | | | | |
Collapse
|
30
|
da Silva A, Costa EC, Gomes JB, Leite FM, Gomez RS, Vasconcelos LP, Krymchantowski A, Moreira P, Teixeira AL. Chronic headache and comorbidities: a two-phase, population-based, cross-sectional study. Headache 2010; 50:1306-12. [PMID: 20163479 DOI: 10.1111/j.1526-4610.2010.01620.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies using resources of a public family health program to estimate the prevalence of chronic daily headaches (CDH) are lacking. OBJECTIVES To estimate the 1-year prevalence of CDH, as well as the presence of associated psychiatric and temporomandibular disorders (TMD) comorbidities, on the entire population of a city representative of the rural area of Brazil. METHODS This was a cross-sectional, population-based, 2-phase study. In the first phase, health agents interviewed all individuals older than 10 years, in a rural area of Brazil. In the second stage, all individuals who reported headaches on 4 or more days per week were then evaluated by a multidisciplinary team. CDH were classified according to the second edition of the International Classification of Headache Disorders (ICHD-2). Medication overuse headache was diagnosed, as per the ICHD-2, after detoxification trials. Psychiatric comorbidities and TMD were diagnosed based on the DSM-IV and on the Research Diagnostic Criteria for Temporomandibular Disorders criteria, respectively. RESULTS A total of 1631 subjects participated in the direct interviews. Of them, 57 (3.6%) had CDH. Chronic migraine was the most common of the CDH (21, 36.8%). Chronic tension-type headache (10, 17.5%), medication overuse headache (13, 22.8%) and probable medication overuse headache (10, 17.5%) were also common. Psychiatric disorders were observed in 38 (67.3%) of the CDH subjects. TMD were seen in 33 (58.1)% of them. CONCLUSIONS The prevalence of CDH in the rural area of Brazil is similar to what has been reported in previous studies. A significant proportion of them have psychiatric comorbidities and/or TMD. In this sample, comorbidities were as frequent as reported in convenience samples from tertiary headache centers.
Collapse
|
31
|
Sances G, Galli F, Anastasi S, Ghiotto N, De Giorgio G, Guidetti V, Firenze C, Pazzi S, Quartesan R, Gallucci M, Nappi G. Medication-Overuse Headache and Personality: A Controlled Study by Means of the MMPI-2. Headache 2010; 50:198-209. [DOI: 10.1111/j.1526-4610.2009.01593.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
32
|
Heckman BD, Holroyd KA, Himawan L, O'Donnell FJ, Tietjen G, Utley C, Stillman M. Do psychiatric comorbidities influence headache treatment outcomes? Results of a naturalistic longitudinal treatment study. Pain 2009; 146:56-64. [PMID: 19660866 DOI: 10.1016/j.pain.2009.06.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 05/05/2009] [Accepted: 06/11/2009] [Indexed: 10/20/2022]
Abstract
This study examined if the presence of one or more psychiatric disorders influences headache treatment outcomes in patients in headache specialty treatment centers. Using a naturalistic, longitudinal design, 223 patients receiving preventive therapy for headache disorders completed 30-day daily diaries that assessed headache days/month and severity at acute therapy baseline and 6-month evaluation and also provided data on headache disability and quality of life at acute therapy baseline, preventive therapy initiation, preventive therapy adjustment, and 6-month evaluation visits. Psychiatric diagnoses were determined using the Primary Care Evaluation for Mental Disorders (PRIME MDs). Of the 223 patients, 34% (n = 76) had no psychiatric disorder, 21% (n = 46) were diagnosed with Depression-Only; 13% (n = 29) were diagnosed with Anxiety-Only; and 32% (n = 72) were diagnosed with Depression-and-Anxiety. Prior to initiating new preventive therapy, patients with one or more psychiatric disorders reported more frequent and disabling headaches and poorer life quality compared to patients with no psychiatric disorders. Rates of improvement in headache days/month, disability, and quality of life were significant and comparable across the four groups. Contrary to clinical wisdom, patients with psychiatric disorders respond very favorably to contemporary headache treatments administered in headache specialty treatment centers.
Collapse
|
33
|
Walsh CA, Jamieson E, Macmillan H, Boyle M. Child abuse and chronic pain in a community survey of women. JOURNAL OF INTERPERSONAL VIOLENCE 2007; 22:1536-1554. [PMID: 17993640 DOI: 10.1177/0886260507306484] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3,381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with physical abuse, mental disorder (anxiety, depression, or substance abuse), or low income. Number of health problems and mental health disorders did not mediate the relationship between physical abuse and chronic pain. Despite considerable evidence from the clinical literature linking exposure to child maltreatment and chronic pain in adulthood, this may well be the first population-based study to investigate this relationship for child physical and sexual abuse independently. The significant association between childhood history of physical abuse and pain in adulthood calls for a greater awareness of the potential for chronic pain problems associated with this type of maltreatment. Further research is needed to understand the mechanism for this complex relationship.
Collapse
|
34
|
Balottin U, Termine C. Recommendations for the management of migraine in paediatric patients. Expert Opin Pharmacother 2007; 8:731-44. [PMID: 17425470 DOI: 10.1517/14656566.8.6.731] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Migraine is a common and disabling condition in children and adolescents. The complexity of migraine on a pathogenetic and clinical level results from the interaction between biological, psychological and environmental factors. Appropriate management requires an individually tailored strategy giving due consideration to both pharmacological and non-pharmacological measures. Ibuprofen (7.5-10.0 mg/kg) and acetaminophen (15 mg/kg) are safe and effective, and should be considered for symptomatic treatment. Sumatriptan nasal spray (5 and 20 mg) is also likely to be effective, but at the moment, should be considered for the treatment of adolescents only. With reference to prophylactic drug treatment, the available data suggest that flunarizine (5 mg/day) is likely to be effective and pizotifen and clonidine are likely to be ineffective. The efficacy data regarding propranolol, nimodipine and trazodone are conflicting. Insufficient evidence is available on cyproheptadine, amitriptyline, divalproex sodium, topiramate, levetiracetam, gabapentin or zonisamide. The management of migraine in children needs an individualised therapeutic approach, directed to the whole person of the child, taking into account the developmental perspective and the high rate of psychiatric comorbidities. It is the authors' opinion that for the prophylaxis of migraine, interventions such as identification and avoidance of trigger factors, regulation of lifestyle, relaxation, biofeedback, cognitive behavioural treatment and psychological or psychotherapeutic interventions (e.g., psychodynamics) could be much more effective than pharmacotherapy.
Collapse
Affiliation(s)
- Umberto Balottin
- Child Neuropsychiatry Unit, Department of Clinical and Biological Sciences, University of Insubria and Macchi Foundation Hospital, Varese, p.zza Biroldi, 19, 21100 Varese, Italy.
| | | |
Collapse
|
35
|
Lanzi G, D'Arrigo S, Termine C, Rossi M, Ferrari-Ginevra O, Mongelli A, Millul A, Beghi E. The effectiveness of hospitalization in the treatment of paediatric idiopathic headache patients. Psychopathology 2007; 40:1-7. [PMID: 17057418 DOI: 10.1159/000096383] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Accepted: 10/27/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Headache is a disease that has a high social impact in the paediatric as well as in the adult population, often resulting in a significant reduction in the young patient's quality of life, reflected primarily in a greater number of days off school and increasingly frequent recourse to symptomatic drugs. The idea for this study came from the clinical impression that some paediatric headache patients might benefit more from inpatient than outpatient care. AIM The aim of our study was to compare the effectiveness of hospitalization to outpatient care of patients with newly diagnosed frequent and disabling headache. METHODS A pragmatic randomized open-label trial was conducted at the Child Neurology Clinic of the University of Pavia, Italy. Children and adolescents with a 2- to 6-month moderate-to-severe migraine or tension-type headache history were randomized to hospital admission or outpatient assessment and followed for 6 months. The efficacy of the two therapeutic strategies was measured by counting the number of responders in each arm. Other end points included the mean frequency and duration of attacks, the number of drug prescriptions taken to control pain, and the number of patients and physicians expressing satisfaction with treatment. RESULTS The study population included 27 girls and 23 boys aged 8 through 18 years with migraine (23 cases) or tension-type headache (27 cases). Compared to outpatient assessment, hospital admission was correlated to a significant increase in the number of responders: 0 vs. 44% (1 month), 0 vs. 68% (3 months), and 12 vs. 68% (6 months). The mean frequency and duration of attacks were significantly lower in hospitalized patients (p < 0.0001). Hospitalization was correlated with a significant reduction of patients with severe headache (p < 0.005), a reduction of drug use, and a higher number of satisfied patients and physicians (p < 0.05). Logistic regression analysis confirmed the higher responder rate among hospitalized patients after adjusting for age, sex, diagnosis, and headache characteristics or admission. CONCLUSIONS We think hospitalization reduces the emotional mechanisms that provoke stress in children and often induce or favour headache attacks. If these mechanisms can be interrupted, the management of disease may become easier and with enduring benefits.
Collapse
Affiliation(s)
- G Lanzi
- Department of Child Neurology and Psychiatry, IRCCS C Mondino Foundation, University of Pavia, Pavia, Italy
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
Medication-overuse headache (MOH) is a clinically important entity and it is now well documented that the regular use of acute symptomatic medication by people with migraine or tension-type headache increases the risk of aggravation of the primary headache. MOH is one the most common causes of chronic migraine-like syndrome. In this article, we analyse the possible mechanisms that underlie sensitization in MOH by comparing these mechanisms with those reported for other forms of drug addiction. Moreover, the evidence for cognitive impulsivity in drug overuse in headache and in other forms of addiction associated with dysfunction of the frontostriatal system will be discussed. An integrative hypothesis for compulsive reward-seeking in MOH will be presented.
Collapse
Affiliation(s)
- Paolo Calabresi
- Clinica Neurologica, Dipartimento di Neuroscienze, Università Tor Vergata, Rome, Italy.
| | | |
Collapse
|
37
|
Lake AE, Rains JC, Penzien DB, Lipchik GL. Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance. Headache 2005; 45:493-506. [PMID: 15953266 DOI: 10.1111/j.1526-4610.2005.05101.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The comorbidity of headache and psychiatric disorders is a well-recognized clinical phenomenon warranting further systematic research. Affective disorders occur with at least three-fold greater frequency among migraineurs than among the general population, and the prevalence increases in clinical populations, especially with chronic daily headache. When present, psychiatric comorbidity complicates headache management and portends a poorer prognosis for headache treatment. However, the relationship between headache and psychopathology has historically been misunderstood, and measures of psychopathology have not always met the standard of formal Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria. In some cases, headache has been inappropriately attributed to psychological or psychiatric features, based on anecdotal observations. The challenge for future studies is to employ research methods and designs that accurately identify and classify the subset of headache patients with psychiatric disorders, evaluate their impact on headache symptoms and treatment, and identify optimal behavioral and pharmacologic treatment strategies. This article offers methodological considerations and recommendations for future research including: (i) ascribing dual-International Classification of Headache Disorders, 2nd ed. (ICHD-2) headache and DSM-IV psychiatric diagnoses according to reliable and valid diagnostic criteria, (ii) differentiating subclinical levels of depression and anxiety from major psychiatric disorders, (iii) encouraging validation studies of the recently published ICHD-2 diagnoses for "headache attributed to psychiatric disorder," (iv) expanding epidemiological research to address the range of DSM-IV Axis I and II psychiatric diagnoses among various headache populations, (v) identifying relevant psychiatric and behavioral mediator/moderator variables, and (vi) developing empirically based screening and treatment algorithms.
Collapse
Affiliation(s)
- Alvin E Lake
- Behavioral Medicine Division, Michigan Head Pain and Neurological Institute, Ann Arbor 48104, USA
| | | | | | | |
Collapse
|