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Rau LM, Humberg C, Könning A, Claus BB, Stahlschmidt L, Wager J. Predictors and concomitants of the remission of frequent headache in pediatrics: A longitudinal community study. Headache 2024; 64:306-316. [PMID: 38440947 DOI: 10.1111/head.14690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE We aimed to examine factors associated with frequent headache remission in schoolchildren aged 10-18 years. BACKGROUND Frequent headache is a common health problem in adolescence, and some individuals in this population experience remission. Factors preceding headache remission as opposed to ongoing headache, and their development over time, have not been examined extensively. METHODS Data were derived from a large school sample (N = 2280). Over the course of 1 year, n = 156 adolescents experienced remission from frequent headaches, while n = 125 adolescents continued to have frequent headaches throughout the year. In this longitudinal case-control study, we predicted headache remission using demographic, pain, psychosocial, sleep, and physiological characteristics. Additionally, we sought to explore the development of psychosocial, sleep, and physiological characteristics in relation to remitted versus ongoing headache over the 1-year period. RESULTS A model containing the variables sex (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.248-0.76, p = 0.003), headache intensity (OR = 0.85, 95% CI = 0.73-0.99, p = 0.035), anxiety score (OR = 0.92, 95% CI = 0.85-1.01, p = 0.071), and depression score (OR = 0.94, 95% CI = 0.89-1.00, p = 0.041) predicted the outcome variable (remitted vs. non-remitted headache), explaining 17% of the variance in group membership. Schoolchildren reporting remitted headache at the end of the year exhibited lower depression (F[1, 557.01] = 45.77, p < 0.001) and anxiety scores (F[1, 557.01] = 21.72, p < 0.001), higher school satisfaction (F[1, 209.46] = 7.15, p = 0.008), and fewer difficulties falling asleep (F[1, 856.52] = 41.21, p < 0.001) or sleeping through the night (F[1, 731.12] = 26.42, p < 0.001) throughout the year compared to those with non-remitted headache. Depression scores declined significantly over the year in the group with remitted headache, whereas these scores remained constant in the group with non-remitted headache. CONCLUSION Our results suggest a correlation between headache remission and male sex, improved mental health, and reduced pain-related burden. Moreover, there was an observed decline in symptoms of depression during headache remission. Psychotherapy may be a promising treatment strategy for addressing frequent headaches reported by children and adolescents.
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Affiliation(s)
- Lisa-Marie Rau
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Clarissa Humberg
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Anna Könning
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Benedikt B Claus
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
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Abu-Arafeh I. Headache and Psychological Comorbidities: An Appraisal of the Evidence. J Clin Med 2023; 12:jcm12072683. [PMID: 37048766 PMCID: PMC10095031 DOI: 10.3390/jcm12072683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND It has been observed that there is a higher-than-expected risk of anxiety and depression in children with chronic headache and also an increased risk for the persistence of headache in patients with anxiety and depression. OBJECTIVES This review aims to identify and assess the relationships between primary headache disorders and comorbid emotional and psychological disorders. METHODS A targeted review of the literature was carried out. RESULTS The associations between the disorders are more pronounced in clinic patients, who may represent the severe end of the headache spectrum, but less clear in patients who were identified in population-based studies and who may represent the "average" child with headache or the "average" child with psychological disorders. CONCLUSIONS Understanding this bidirectional association of comorbid disorders is of great importance to offering a holistic biopsychosocial approach to the management of headache disorders in children and adolescents and in addressing the risks for and the co-existence of psychological comorbidities.
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Affiliation(s)
- Ishaq Abu-Arafeh
- Paediatric Neurosciences Unit, Royal Hospital for Children, Glasgow G51 4TF, UK
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Güler Aksu G, Kayar O, Tufan AE, Kütük MÖ, Sucu DH, Taşdelen B, Toros F, Özge A. Early maladaptive schemas differing according to sex may contribute to migraine among the youth. Brain Dev 2022; 44:427-437. [PMID: 35459526 DOI: 10.1016/j.braindev.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/19/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Despite many diverse findings from studies about the comorbidity of psychiatric disorders and migraine, there are still unknown points. Schemas, which are the basic structures of cognition, are understudied. This study examined the effects of sex on early maladaptive schemas (EMSs) and the clinical characteristics of migraine in adolescents with migraine. METHODS The sample comprised 171 adolescents (67.3% females, n = 115) aged 12-18 years. The clinical characteristics of migraine (duration, severity, frequency of headaches, etc.), accompanying symptoms (nausea, vomiting, photophobia, etc.) and EMSs were evaluated depending on sex. Psychopathology and abuse history were analyzed as covariates in this study. RESULTS The mean age was 15.4 ± 1.9 among the females and 15.2 ± 2.0 among the males (p = 0.65). There was no difference in terms of migraine characteristics, and except for dizziness and pain relief by massage, all other symptoms were similar between the sexes. Female adolescent migraineurs significantly elevated scores for EMS of emotional deprivation, abandonment/instability, defectiveness/shame (disconnection/rejection domain), dependence/incompetence, vulnerability to harm/illness, failure (in impaired autonomy/performance domain) and negativity/pessimism (in hypervigilance/inhibition domain). On the other hand, male migraineurs had significantly elevated scores only in insufficient self-control/self-discipline (in impaired limits domain). Type of migraine and current psychopathology had no significant effect on the EMS domains, while sexual abuse history significantly affected some EMS. CONCLUSION Our study highlights the importance of screening for EMSs among adolescent patients with migraine. Schema therapy and similar therapeutic interventions may be used in the management of migraine in adolescents. Gender may also be important factor the schema therapy in adolescent migraine patients.
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Affiliation(s)
- Gülen Güler Aksu
- Department of Child and Adolescent Psychiatry, Mersin University School of Medicine, Mersin, Turkey.
| | - Ozan Kayar
- Department of Psychology, Çankırı Karatekin University, Çankırı, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Abant İzzet Baysal University, Bolu, Turkey
| | - Meryem Özlem Kütük
- Department of Child and Adolescent Psychiatry, Başkent University School of Medicine, Adana, Turkey
| | - Damla Hazal Sucu
- Department of Biostatistics and Medical Informatics, Mersin University School of Medicine, Mersin, Turkey
| | - Bahar Taşdelen
- Department of Biostatistics and Medical Informatics, Mersin University School of Medicine, Mersin, Turkey
| | - Fevziye Toros
- Department of Child and Adolescent Psychiatry, Mersin University School of Medicine, Mersin, Turkey
| | - Aynur Özge
- Department of Neurology, Mersin University School of Medicine, Mersin, Turkey
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Polese D, Belli A, Esposito D, Evangelisti M, Luchetti A, Di Nardo G, Parisi P, Bruni O. Psychological Disorders, Adverse Childhood Experiences and Parental Psychiatric Disorders in Children Affected by Headache: A Systematic Review. Neurosci Biobehav Rev 2022; 140:104798. [PMID: 35907492 DOI: 10.1016/j.neubiorev.2022.104798] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/23/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Pediatric headaches have been linked to adverse life events or psychological factors in children and their families, with a complex and bidirectional association. Moreover, it is well-known that psychological stress can trigger headaches. METHODS We searched three databases for studies focusing on headaches and adverse events or psychological factors in children up to 12 years old or in their caregivers. RESULTS We included 28 studies. Child psychological factors, including internal and external symptoms, were commonly associated with all types of headaches. Sleep disturbances showed a positive association with headaches in 3 out of 5 studies. Family conflict and unhappiness were frequently found in children suffering with headaches, while single-parent families and divorce were not associated. Stressful environments and adverse life events, particularly bullying, were also found to be linked with headaches. CONCLUSIONS Childhood headaches represent an alarm bell for clinicians to investigate and treat psychological or psychiatric disorders in children and their family. Further studies are needed to elucidate the role of early-life adverse events in children and their families.
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Affiliation(s)
- Daniela Polese
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "Sapienza" University of Rome, Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Arianna Belli
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, Via dei Sabelli 108 - 00185 Rome, Italy
| | - Dario Esposito
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, Via dei Sabelli 108 - 00185 Rome, Italy
| | - Melania Evangelisti
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University c/o Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Anna Luchetti
- "Sapienza" University of Rome, Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University c/o Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University c/o Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Oliviero Bruni
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "Sapienza" University of Rome, Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy; Department of Social and Developmental Psychology, Sapienza University, Via dei Marsi 78 - 00185 Rome, Italy.
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5
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Shimomura H. Emotional Problems in Pediatric Headache Patients. Curr Pain Headache Rep 2022; 26:469-474. [DOI: 10.1007/s11916-022-01045-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 12/21/2022]
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Abstract
BACKGROUND Pain has been qualified under four categories: nociception, perception of pain, suffering, and pain behaviors. Most of the literature on migraine has devoted attention to the first two. The aim of the present cohort study was to investigate patients with migraine enrolled at a tertiary care unit to study suffering and mental pain and identify potential risk factors for migraine. METHODS An observational cross-sectional study was carried out on patients with chronic migraine (CM) and episodic migraine (EM), and healthy subjects (HS). The three groups were matched for age and sex. A comprehensive assessment of migraine disability, pain, psychiatric disorders, psychosomatic syndromes, depressive and anxious symptoms, euthymia, psychosocial variables, mental pain, and pain-proneness (PP) was performed. RESULTS Three hundred subjects were enrolled (100 CM, 100 EM, and 100 HS). Based on the multiple regression analyses, those presenting PP (social impairment: odds ratio [OR] = 3.59, 95% confidence interval [CI] = 1.14-11.29; depressive symptoms: OR = 3.82, 95% CI = 1.74-8.41) were more likely to be CM than HS. Those with higher levels of PP (social impairment: OR = 4.04, 95% CI = 1.60-10.22; depressive symptoms: OR = 2.02, 95% CI = 1.26-3.24) were more likely to be EM than HS. Those presenting higher levels of mental pain were more likely to be CM than EM (OR = 1.45, 95% CI = 1.02-2.07). CONCLUSION Migraine is an unpleasant sensory and emotional experience associated with psychosocial manifestations that might contribute to the level of suffering of the individuals. Mental pain resulted to be the variable that most differentiated patients with CM from EM.
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Srouji R, Schenkel SR, Forbes P, Cahill JE. Dihydroergotamine infusion for pediatric refractory headache: A retrospective chart review. Headache 2021; 61:777-789. [PMID: 34105158 DOI: 10.1111/head.14117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Headaches are a common symptom in children. Children with refractory headaches may be admitted for inpatient treatment with intravenous dihydroergotamine mesylate (DHE). However, very few studies have characterized these patients and their treatment outcomes using validated, self-reported, pain scales. OBJECTIVE The objective of this study was to describe demographic and clinical characteristics of children admitted for DHE infusion, determine DHE treatment outcomes by means of numeric pain scale ratings, and explore associations between treatment outcomes and clinical characteristics. METHODS Retrospective chart review was completed in patients ages 5-21 admitted for DHE infusion from January 2013 to July 2018 at a large, pediatric academic medical center and community-based satellite center. All primary headache types were included. RESULTS A total of 200 unique admissions for DHE were available for analysis. Overall, patients were predominantly White (87.5%, 175/200) and female (80.0%, 160/200) with an average age of 15.4 years (SD 2.3). Common comorbidities included obesity (42.0%, 81/193), anxiety (41.0%, 82/200), and depression (20.0%, 40/200). The mean length of stay was 2.4 days (SD 1.10; range 1-8 days). Most headaches (65.0%, 130/200) met the International Classification of Headache Disorders, 3rd edition criteria for migraine, followed by new daily persistent headache (25.5%, 51/200). Mean DHE maximum dose was 5.3 (SD 2.17; range 0.5-14.5 mg) with most patients requiring 3.5-6.5 mg. DHE was typically terminated at six doses (range 1-15). The most frequently reported adverse event was nausea (5.5%, 11/200). There was no difference in pain severity at admission across headache types, with an average baseline pain score of 8.1 (SD 1.6). Posttreatment reduction in pain score was statistically significant (range: -3.2 to -4.9; each p < 0.001) across all headache types. Overall, 84.0% (168/200) of the patients had some improvement in pain. More than half of the patients (53.5%, 107/200) showed at least moderate improvement (≥50.0% reduction in pain score), and 18.0% (36/200) had full headache resolution. Limited patients (16.0%, 32/200) experienced no improvement in pain. CONCLUSIONS Treatment with DHE resulted in at least some improvement for most patients regardless of headache type or number of doses. Clinical trials stratified by headache type and comorbid factors could help clarify treatment algorithms to optimize patient outcomes.
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Affiliation(s)
- Rasha Srouji
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Sara R Schenkel
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Peter Forbes
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
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Gazerani P. Migraine and Mood in Children. Behav Sci (Basel) 2021; 11:bs11040052. [PMID: 33919881 PMCID: PMC8070834 DOI: 10.3390/bs11040052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
Migraine is one of the most prevalent headache disorders in children and negatively influences their quality of life. Physical, social, and school functioning are negatively affected. Mood changes are common in migraineurs and may happen before, during, or after a migraine headache. Children with migraine are not exempt from mood swings. The majority of mood changes occur during the prodromal phase, manifesting as a psychobiological response, e.g., difficulty thinking, trouble concentrating, irritability, higher or lower energy, confusion, and depression. A bi-directional relationship between migraine and mood has been proposed, but mechanisms are not clear. Collectively, a maladaptive stress response has been suggested to explain the inability to balance homoeostatic changes when facing various stressors. Recognizing mood changes and monitoring mood patterns in children with migraine, for example, by various apps and so-called mood monitors, is valuable for better management. A multidisciplinary intervention has been recommended to reduce migraine disability, improve coping strategies, and reduce chronification risks in children with migraine. Pharmacological and non-pharmacological strategies are both available and effective. Biofeedback, relaxation, and cognitive-behavioral therapy yield positive outcomes in pediatric migraine. Developing healthy lifestyle habits (diet, exercise, sleep) also seems to improve migraine in this population.
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Affiliation(s)
- Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway;
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9229 Aalborg E, Denmark;
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The Co-occurrence of Pediatric Chronic Pain and Depression: A Narrative Review and Conceptualization of Mutual Maintenance. Clin J Pain 2020; 35:633-643. [PMID: 31094934 DOI: 10.1097/ajp.0000000000000723] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Internalizing mental health issues co-occur with pediatric chronic pain at high rates and are linked to worse pain and functioning. Although the field has prioritized anxiety and posttraumatic stress disorder, little is known about co-occurring depression and chronic pain in youth, despite its high prevalence. The purpose of this narrative review was to examine the existing literature on the co-occurrence of pediatric chronic pain and depressive disorders and symptoms and propose a conceptual model of mutual maintenance to guide future research. METHODS The literature from both fields of pediatric pain and developmental psychology were searched to review the evidence for the co-occurrence of pediatric chronic pain and depression. Conceptual models of co-occurring mental health issues and chronic pain, as well as child depression, were reviewed. From both literatures, we provide evidence for a number of proposed child, parent, and neurobiological factors that may serve to mutually maintain both conditions over time. On the basis of this evidence, we propose a conceptual model of mutual maintenance and highlight several areas for future research in this area. RESULTS Evidence was found for the prevalence of depression in pediatric chronic pain as well as the co-occurrence of both conditions. The key mutually maintaining factors identified and proposed included neurobiological, intrapersonal (eg, cognitive biases, sleep disturbances, emotion regulation, and behavioral inactivation), and interpersonal (eg, parent mental health and pain, genes, and parenting) factors. DISCUSSION Given the dearth of research on mutual maintenance in this area, this review and conceptual model could drive future research in this area. We argue for the development of tailored treatments for this unique population of youth to improve outcomes.
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Lee DH, Kim KM, Cho SJ, Kim WJ, Yang KI, Yun CH, Chu MK. Impacts of migraine on the prevalence and clinical presentation of depression: A population-based study. J Affect Disord 2020; 272:215-222. [PMID: 32553361 DOI: 10.1016/j.jad.2020.03.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/29/2020] [Accepted: 03/28/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND A close association has been reported between depression and migraine. However, information concerning the impacts of migraine on the clinical presentation and prevalence of depression in a population-based study is currently limited. METHODS Data from the Korean Headache-Sleep Study, a nationwide survey about headache and sleep for adults aged 19-69 years were used. Depression was defined when Patient Health Questionnaire-9 score ≥ 10. RESULTS Of 2,695 participants who included in this study, 116 (4.3%), 143 (5.3%), and 1130 (41.9%) had depression, migraine, and non-migraine headache, respectively. Migraine (24/116 [20.5%] vs. 119/2579 [4.7%], p < 0.001) and non-migraine headache (67/116 [58.1%] vs. 1063/2579 [41.3%], p < 0.001) was more prevalent in the group of participants with depression than among participants without depression. Among participants with depression, there was no statistically differences in total Patient Health Questionnaire-9 (PHQ-9) scores among migraine, non-migraine headache, and non-headache groups (median with interquartile range, 12.0 [10.2-18.0] vs. 13.0 [11.0-16.0] vs. 12.0 [10.0-15.2], p = 0.514). Among subcomponent scores of PHQ-9, all subcomponent scores did not significantly differ by headache status except feeling tired or having little energy scores (non-migraine headache 2.0 [2.0-3.0] vs. non-headache 2.0 [1.0-2.0], p = 0.010). LIMITATIONS Diagnosis of depression based on PHQ-9 questionnaire and small sample size in subgroup analyses. CONCLUSIONS Participants with depression exhibit an increased risk of migraine and non-migraine headache compared with participants without depression. Among participants with depression, the severity of depression did not significantly differ on the basis of headache status.
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Affiliation(s)
- Dong Hyun Lee
- Department of Neurology, Yeungnam University of College of Medicine, Daegu, Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea
| | - Kwang Ik Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Chang-Ho Yun
- Department of Neurology, Bundang Clinical Neuroscience Institute, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea.
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Jeyagurunathan A, Abdin E, Vaingankar JA, Chua BY, Shafie S, Chang SHS, James L, Tan KB, Basu S, Chong SA, Subramaniam M. Prevalence and comorbidity of migraine headache: results from the Singapore Mental Health Study 2016. Soc Psychiatry Psychiatr Epidemiol 2020; 55:33-43. [PMID: 31456029 DOI: 10.1007/s00127-019-01755-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Migraine is a highly prevalent and disabling neurological disorder associated with a wide range of psychiatric comorbidities. Studies have revealed that those with migraine headache and coexisting psychiatric disorders have poorer treatment outcomes and increased disability. The study aims to establish the prevalence, correlates, and comorbidities of migraine headache among the multi-ethnic Asian population in Singapore. METHOD Data were extracted from the Singapore Mental Health Study 2016 (SMHS 2016), a cross-sectional epidemiological survey of a nationally representative sample. Face-to-face interviews were completed with 6126 participants between 2016 and 2017. The data relating to chronic medical conditions, psychiatric conditions, and 30-day functioning and disability were captured using the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0. RESULTS The lifetime prevalence for migraine headache in the Singapore general population was 8.2%. Malay ethnicity (versus Chinese), female gender (versus male), and diploma holders (versus university) were significantly more likely to experience migraine headache. Participants belonging to the older age group (65 years and above versus 18-34 years of age), and those who were economically inactive (versus employed) were less likely to experience migraine headache. The mean age of onset for migraine was 26.4 years (SD = 11.1). Poisson regression analyses showed that migraine headache was also significantly associated with psychiatric conditions such as major depressive disorder (MDD) (prevalence ratio (PR), 1.80; 95% CI, 1.25-2.58), bipolar disorder (BD) (PR, 3.55; 95% CI, 2.29-5.51), generalized anxiety disorder (GAD) (PR, 2.04; 95% CI, 1.12-3.69), obsessive compulsive disorder (OCD) (PR, 2.20; 95% CI, 1.49-3.26), and alcohol use disorder (AUD) (PR, 1.93; 95% CI, 1.20-3.08). Those with migraine headache were significantly associated with poor functioning and disability compared to those without migraine headache. CONCLUSIONS AND DISCUSSION Our study showed significant associations between migraine headache and psychiatric disorders, as well as with role functioning and disability. The findings of our study emphasise the need for screening for psychiatric comorbidity among those with migraine and the development of appropriate interventions for this group.
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Affiliation(s)
- Anitha Jeyagurunathan
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Saleha Shafie
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Shi Hui Sherilyn Chang
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Lyn James
- Ministry of Health (MOH), Singapore, Singapore
| | | | - Sutapa Basu
- Early Psychosis Intervention Programme (EPIP), Department of Psychosis, IMH, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
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Hammond NG, Orr SL, Colman I. Early Life Stress in Adolescent Migraine and the Mediational Influence of Symptoms of Depression and Anxiety in a Canadian Cohort. Headache 2019; 59:1687-1699. [DOI: 10.1111/head.13644] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Nicole G. Hammond
- School of Epidemiology and Public Health University of Ottawa Ottawa ON Canada
| | - Serena L. Orr
- Department of Pediatrics University of Calgary Calgary AB Canada
| | - Ian Colman
- School of Epidemiology and Public Health University of Ottawa Ottawa ON Canada
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Woods K, Ostrowski-Delahanty S, Cieplinski T, Winkelman J, Polk P, Victorio MC. Psychosocial and Demographic Characteristics of Children and Adolescents With Headache Presenting for Treatment in a Headache Infusion Center. Headache 2019; 59:858-868. [PMID: 31008518 DOI: 10.1111/head.13537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Approximately 10% of pediatric patients have recurrent headaches, with migraine being the most common headache type. If untreated, migraine may progress to status migrainosus, a debilitating condition of prolonged duration, high pain severity, and significant disability. There is high variability in the treatment of status migrainosus including medications used and treatment setting, which may occur in the emergency room, as an inpatient admission, or, less often, in an outpatient infusion center. The paucity of research on the treatment of status migrainosus is a limitation to treatment effectiveness. OBJECTIVE The objective of the study was twofold. First, we sought to examine the demographic characteristics of children and adolescents accessing our outpatient infusion center for prolonged headache. Second, we sought to determine whether any demographic or psychosocial differences exist between patients who access infusion therapy compared to patients who do not access infusion therapy for their headaches. METHODS We conducted a retrospective chart review of all patients between the ages of 6 and 19 years who were treated in our outpatient headache infusion center. A subset of these patients completed a behavioral health evaluation (treatment group) and they were compared to a control group of similar age (birthdate within 6 months) and gender to patients not seeking infusion treatment. Variables of interest included patient demographics, headache type and characteristics, and scores on the Pediatric Quality of Life Inventory (PedsQL), Functional Disability Inventory (FDI), Pediatric Pain Coping Inventory (PPCI), and the Behavior Assessment System for Children - Second Edition (BASC-2). RESULTS A total of 284 patients were included in the study (n = 227 receiving infusion treatment and n = 57 controls). Patients were primarily female (224/286; 78.9%), Caucasian (254/286; 90.1%), and had a mean age of 15 years. Findings suggest a promising difference in the PPCI Distraction subscale, χ2 (1) = 3.7, P = .054, with a mean rank score of 61.90 for the treatment group and 50.21 for the control group. Additionally, a statistically significant difference was noted on the Social Support subscale, χ2 (1) = 10.6, P = .001, with a mean rank score of 65.92 for the treatment group and 46.26 for the control group. Results also indicated a statistically significant difference in disability scores, χ2 (1) = 10.0, P = .002, with a mean rank FDI score of 66.83 for the treatment group and 47.34 for the control group. Patients in the infusion group also reported lower quality of life on the PedsQL Total score (F[1, 109] = 5.0, P = .028; partial η2 = 0.044), and on the Physical (F[1, 109] = 7.9, P = .006; partial η2 = 0.069) and School (F[1, 109] = 4.6, P = .035; partial η2 = 0.041) subscales. No significant differences were found on the BASC-2. Parent reported data also revealed a significantly higher level of disability among patients seeking infusion treatment compared to the non-infusion group χ2 (1) = 11.7, P = .001. However, there were no significant differences on the PedsQL, PPCI, or BASC-2. CONCLUSIONS Our findings support the disabling nature of migraine among children and adolescents, with higher levels of disability and lower quality of life reported in the group of patients utilizing infusion treatment. Developing concrete treatment plans and goals combined with bio-behavioral therapy are necessary to reduce functional disability and increase quality of life among these patients. Awareness of this patient group's pain-related coping strategies may help health care providers tailor treatment recommendations and develop or refine cognitive-behavioral headache treatment techniques.
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Affiliation(s)
- Kristine Woods
- NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, OH, USA
| | | | - Tami Cieplinski
- NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, OH, USA
| | - Jonathan Winkelman
- NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, OH, USA
| | - Pretti Polk
- NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, OH, USA
| | - M Cristina Victorio
- NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, OH, USA
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Manczak EM, Dougherty B, Chen E. Parental Depressive Symptoms Potentiate the Effect of Youth Negative Mood Symptoms on Gene Expression in Children with Asthma. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:99-108. [PMID: 29556870 PMCID: PMC6148436 DOI: 10.1007/s10802-018-0420-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Depressive symptoms in parents and in youths have been found to relate to disease comorbidity processes in children, including greater disease-related impairment and poorer clinical outcomes. The current study sought to assess whether coming from a family characterized by more depressive symptoms on average would potentiate the effects of changes in youths' own negative mood on the expression of two receptor genes relevant to asthma that are the primary targets of asthma medication, such that the combination of low child negative mood in the context of greater parental depressive symptoms would relate to the lowest levels of gene expression. One-hundred-twenty youths with diagnosed asthma and their parents participated every 6 months for 2 years. Parents reported on their depressive symptoms, children reported negative mood symptoms, and youths completed blood draws from which expression of Glucocorticoid Receptor (GR) and Beta2 Adrenergic Receptor (β2-AR) genes was extracted. Multilevel linear modeling revealed significant interactions between average levels of parental depressive symptoms and changes in youths' negative mood symptoms predicting gene expression, such that youths expressed significantly less GR and β2-AR during times when they experienced more negative mood symptoms, but this was only true if they came from families with higher levels of average parental depressive symptoms. The current study identifies novel and biologically-proximal molecular signaling patterns that connect depressive symptoms to pediatric asthma while also highlighting the important role of family environment for biological processes that may operate within depression comorbidity.
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Affiliation(s)
- Erika M Manczak
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA.
| | - Bryn Dougherty
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Edith Chen
- Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL, USA
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15
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Orr SL, Kabbouche MA, O’Brien HL, Kacperski J, Powers SW, Hershey AD. Paediatric migraine: evidence-based management and future directions. Nat Rev Neurol 2018; 14:515-527. [DOI: 10.1038/s41582-018-0042-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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16
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[The impact of catastrophizing on the effect of depression on pain and functional ability : A longitudinal mediator analysis]. Schmerz 2018; 31:159-166. [PMID: 27858219 DOI: 10.1007/s00482-016-0172-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND While the association between pain and depression is well proven, little is known about the mechanisms influencing this relationship. The cognitive distortion of catastrophizing plays a significant role in several concepts of both diseases. OBJECTIVE The aim of the study was to analyze the role of catastrophizing on the effect of depression on pain and functional ability. MATERIAL AND METHODS Participants were recruited from 11 outpatient rehabilitation centers in Germany at the beginning of orthopedic rehabilitation aftercare. Perceived functional ability (spinal function sort), pain intensity (rating scales) and physical functioning (36-item Short-Form Health Survey, SF-36) were assessed as dependent variables at the beginning of the aftercare (T1) as well as 6 months later (T2). The independent variable depression (Patient Health Questionnaire and Mental Health Index of the SF-36) as well as the mediator catastrophizing (Coping Strategies Questionnaire) were measured at T1. Pathway models were used to analyze the direct and indirect proportions of the total effect of an independent variable on a dependent variable and the role of catastrophizing as a mediator of this association. RESULTS A total of 241 patients were included in the analyses. Depression had a significant total effect on pain as well as functional capacity. Catastrophizing mediated substantial proportions of these effects (42.9-87.1%). CONCLUSION Catastrophizing mediates the relationship between depression and pain as well as functional capacity; therefore, the reduction of catastrophizing thoughts and attitudes should be a focus in rehabilitation programs.
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17
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Bung S, Saile H, Laessle R. [Stress related correlates of anxiety and depression in girls with chronic headache]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 46:41-46. [PMID: 27873540 DOI: 10.1024/1422-4917/a000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic headache in adolescents is frequent and often associated with anxiety and depression. The present study investigated, whether psychological and physical stress symptoms have an infl uence on the occurrence of anxiety and depression and what is the role of stress coping. The sample consisted of 77 15 years old girls with chronic headache and 72 girls, who served as controls. Stress symptoms and stress coping were measured with the Stressverarbeitungsfragebogen für Kinder und Jugendliche (Coping with Stress Questionnaire for Children and Adolescents), depression was assessed by the Depression Inventory for Children and Adolescents, anxiety by the State-Trait Anxiety Inventory for Children. Linear regression was used to analyze the relationship between stress factors and anxiety resp. depression. Physical stress symptoms were related to anxiety, but not to depression. Coping strategies of the depressed as well as the anxious children were characterized by stress reinforcing behaviors. The results point to focusing on physical symptoms in the anxious headache patients and to avoidance coping in the depressed children.
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Affiliation(s)
- Simone Bung
- 1 Abteilung für Biologische und Klinische Psychologie, Universität Trier
| | - Helmut Saile
- 1 Abteilung für Biologische und Klinische Psychologie, Universität Trier
| | - Reinhold Laessle
- 1 Abteilung für Biologische und Klinische Psychologie, Universität Trier
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18
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Systematic Review of Childhood and Adolescent Risk and Prognostic Factors for Recurrent Headaches. THE JOURNAL OF PAIN 2016; 17:855-873.e8. [DOI: 10.1016/j.jpain.2016.03.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/18/2016] [Accepted: 03/15/2016] [Indexed: 11/24/2022]
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19
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Mazzone L, Vitiello B, Incorpora G, Mazzone D. Behavioural and Temperamental Characteristics of Children and Adolescents Suffering from Primary Headache. Cephalalgia 2016; 26:194-201. [PMID: 16426275 DOI: 10.1111/j.1468-2982.2005.01015.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To examine indices of behavioural and emotional problems and temperamental traits in clinically referred children and adolescents suffering from tension headache or migraine. Headache in childhood and adolescence (<18 years) has been associated with the presence of behavioural and emotional difficulties, but limited data are available on the relationship between these problems and different types of headache. Clinically referred children and adolescents ( N = 114), 6–16 years of age, suffering from primary headache according to the diagnostic criteria of the International Headache Society, 47 with tension-type headache (TH) and 67 with migraine (M), and 36 normal controls without headache (NC) were assessed using the Parent Child Behaviour Checklist (CBCL), Children's Depression Inventory (CDI), Multidimensional Anxiety Scale for Children (MASC), Conner's Parent Rating Scale (CPRS), and Emotionality–Activity–Sociability–Shyness Scale (EAS). Psychological and personality self-rating assessments were obtained also on the children's parents and siblings. Although most headache patients had scores within the normative non-pathological range, both TH and M patients had higher CBCL total, internalizing, and externalizing scores than NC ( P < 0.001), and TH patients had higher scores than M patients. TH and M had higher CDI and MASC scores than NC ( P < 0.05), with no difference between the headache groups. TH patients had higher Emotionality and Shyness scores, and lower Sociability scores than M patients. Clinically referred children and adolescents with TH and M had higher scores of behavioural and emotional symptoms, both of internalizing and externalizing type, than normal peers. The TH group had greater psychological and temperamental difficulties than the M group.
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Affiliation(s)
- L Mazzone
- Division of Child Neurology and Psychiatry, Department of Paediatrics, University of Catania, Catania, Italy.
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20
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Laimi K, Metsähonkala L, Anttila P, Aromaa M, Vahlberg T, Salminen JJ, Sillanpää M. Outcome of Headache Frequency in Adolescence. Cephalalgia 2016; 26:604-12. [PMID: 16674770 DOI: 10.1111/j.1468-2982.2004.01084.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Only a few studies have been published of the outcome of adolescent headache (HA). The aim of this study was to examine the predictors of the outcome of headache frequency. A population-based sample of 13-year-olds with or without HA ( N = 228) was followed to the age of 16 years. HA was classified on the basis of a face-to-face interview and clinical examination. The outcomes of monthly HA (>1/month) and non-frequent HA (0-1/month) were studied. Frequent use of analgesics, female gender and multiple non-headache pain predicted the persistence of monthly HA (>1/month). Significant predictors for worsening non-frequent HA (from 0 to 1/month to >1/month) were female gender, consistent migraine and high basic educational level of one parent. Adolescents frequently using analgesics constitute a risk group for a poor outcome of HA. Especially girls meeting this criterion should be considered a target group in the planning and implementing of preventive measures.
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Affiliation(s)
- K Laimi
- Department of Physical and Rehabilitation Medicine, Turku University Central Hospital, Turku, Finland.
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21
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Öztop DB, Taşdelen Bİ, PoyrazoğLu HG, Ozsoy S, Yilmaz R, Şahın N, Per H, Bozkurt S. Assessment of Psychopathology and Quality of Life in Children and Adolescents With Migraine. J Child Neurol 2016; 31:837-42. [PMID: 26759448 DOI: 10.1177/0883073815623635] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/10/2015] [Indexed: 11/16/2022]
Abstract
AIM The aims of this study were to investigate comorbid psychiatric disorders and to identify anxiety and depression levels and quality of life in children and adolescents with migraine; and to assess their relationship with migraine. METHOD 35 patients aged 9-16 years were followed in our neurology clinic and their parents were included into the study. 35 age- and sex-matched patients were employed as the control group. In the subjects included, psychiatric disorders were assessed by using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version. All children and adolescents were assessed by using the Children's Depression Inventory, the State-Trait Anxiety Inventory and the Pediatric Quality of Life Inventory. In addition, the Pediatric Migraine Disability Assessment Tool and visual analog scale were used to identify the degree of disability and pain severity in patients with migraine. FINDINGS In the psychiatric assessment of children and adolescents with migraine, it was found that a psychiatric diagnosis was made in 40% of patients; and depression scale scores were significantly higher than those of controls. Quality of life was found to be poorer in patients with migraine compared to controls. It was found that quality of life was negatively correlated with pain severity and degree of disability; while it was positively correlated with depression scores. DISCUSSION In children and adolescents with migraine, treatment of psychiatric disorders in addition to migraine therapy can facilitate migraine management and may decrease the need for prophylactic therapy.
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Affiliation(s)
- Didem Behice Öztop
- Child and Adolescent Psychiatry, Erciyes University School of Medicine, Kayseri, Turkey
| | - Bedia İnce Taşdelen
- Child and Adolescent Psychiatry, Elazığ Mental Health Hospital, Elazığ, Turkey
| | | | - Saliha Ozsoy
- Department of Psychiatry, Erciyes University Medical School, Kayseri, Turkey
| | - Rabia Yilmaz
- Department of Child Psychiatry, Erciyes University School of Medicine, Kayseri, Turkey
| | - Nilfer Şahın
- Child and Adolescent Psychiatry Department, School of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Hüseyin Per
- Department of Child Neurology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Selma Bozkurt
- Child and Adolescent Psychiatry, Erciyes University School of Medicine, Kayseri, Turkey
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22
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Kabbouche M, Khoury CK. Management of Primary Headache in the Emergency Department and Inpatient Headache Unit. Semin Pediatr Neurol 2016; 23:40-3. [PMID: 27017021 DOI: 10.1016/j.spen.2015.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Migraine is a chronic disorder with debilitating exacerbations throughout the lifetime of migraineurs. Children and adolescents are significantly affected. The prevalence of migraine in this age group is higher than predicted in the last decade. Fortunately, this chronic disease is getting more attention and recognition, and better treatments are now being offered to these patients. Different medications are available, mostly for the outpatient management of an attack and include the use of over-the-counter anti-inflammatory medications as well as prescribed medications like the triptans group. These therapies do sometime fail and the exacerbations can last days to weeks. Early aggressive intravenous treatment can be very effective in breaking the attack and allowing the child to be functional faster and sometimes may prevent chronification of an attack.
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Affiliation(s)
- Marielle Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Chaouki K Khoury
- Texas A&M Health Sciences Center, Round Rock, TX; Baylor University Medical Center and Our Children's House at Baylor, Dallas, TX
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23
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Kaczynski K, Gambhir R, Caruso A, Lebel A. Depression as a mediator of the relation between family functioning and functional disability in youth with chronic headaches. Headache 2015; 56:491-500. [DOI: 10.1111/head.12709] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Karen Kaczynski
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine; Children's Hospital Boston and Harvard Medical School; Boston MA USA
- Department of Psychiatry; Children's Hospital Boston and Harvard Medical School; Boston MA USA
| | - Rupa Gambhir
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine; Children's Hospital Boston and Harvard Medical School; Boston MA USA
- Department of Psychiatry; Children's Hospital Boston and Harvard Medical School; Boston MA USA
| | - Alessandra Caruso
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine; Children's Hospital Boston and Harvard Medical School; Boston MA USA
| | - Alyssa Lebel
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine; Children's Hospital Boston and Harvard Medical School; Boston MA USA
- Department of Neurology; Children's Hospital Boston and Harvard Medical School; Boston MA USA
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24
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Kabbouche M. Management of Pediatric Migraine Headache in the Emergency Room and Infusion Center. Headache 2015; 55:1365-70. [PMID: 26486800 DOI: 10.1111/head.12694] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022]
Abstract
Migraine is a common disorder that starts at an early age and takes a variable pattern from intermittent to chronic headache with several exacerbations throughout a lifetime. Children and adolescents are significantly affected. If an acute headache is not aborted by outpatient migraine therapy, it often causes severe disability, preventing the child from attending school and social events. Treating the acute severe headache aggressively helps prevent prolonged disability as well as possible chronification. Multiple medications are available, mostly for the outpatient management of an attack and include the use of over-the-counter anti-inflammatory medications as well as prescribed medications in the triptan group. These therapies do sometime fail and the exacerbation can last from days to weeks. If the headache lasts 72 hours or longer it will fall in the category of status migrainosus. Status migrainosus is described as a severe disabling headache lasting 72 hours or more by the ICHD3 criteria. Disability is a major issue in children and adolescents and aggressive acute measures are to be taken to control it as soon as possible. Early aggressive intravenous therapy can be very effective in breaking the attack and allowing the child to be quickly back to normal functioning. This article reviews what is available for the treatment of pediatric primary headaches in the emergency room.
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Affiliation(s)
- Marielle Kabbouche
- Division of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH, 45229-3039, USA (M. Kabbouche).,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229-3039, USA (M. Kabbouche)
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25
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Yalinay Dikmen P, Yavuz BG, Aydinlar EI. The relationships between migraine, depression, anxiety, stress, and sleep disturbances. Acta Neurol Belg 2015; 115:117-22. [PMID: 24889393 DOI: 10.1007/s13760-014-0312-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/13/2014] [Indexed: 11/24/2022]
Abstract
To assess the relationships between migraine, depression, anxiety, stress, and sleep problems. Psychiatric conditions and sleep disturbances are common in migraineurs. Depression, anxiety, stress, migraine, and sleep problems frequently coexist as comorbidities. Eighty-seven episodic migraineurs (62 females, 25 males; 32.8 ± 6.9) and 41 control subjects (25 females, 16 males; 31.5 ± 5.6) were prospectively enrolled for the study. The participants completed a sociodemographic data form and a migraine disability assessment scale (MIDAS), depression, anxiety, stress scale (DASS), and Pittsburg Sleep Quality Index (PSQI). In migraineurs, a significant positive correlation was found between PSQI total scores and MIDAS scores (migraine related disability for at least three consecutive months) (r = 0. 234, p = 0.04). Only 24.1 % of migraineus (n = 21) had minimal or no disability, 75.9 % of the patients (n = 66) had more than a little disability according to MIDAS scores. PSQI total scores were also correlated with pain intensity over a three month period (MIDAS B) (r = 0.221, p = 0.04). While PSQI scores were found significantly different between migraineurs and control subjects (5.5 ± 2.9 vs 4.5 ± 2.5; p = 0.04), the correlation of all the DASS subscale scores between the groups was not statistically significant. Our findings showed that episodic migraine was a risk factor on its own for sleep disturbances without comorbid depression, anxiety, and stress. Moreover, migraine-related disability and pain intensity in migraine attacks were related to poor sleep quality.
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Affiliation(s)
- Pinar Yalinay Dikmen
- Neurology Department, School of Medicine, Acibadem University, Istanbul, Turkey,
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26
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Chronic multisite pain in adolescent girls and boys with emotional and behavioral problems: the Young-HUNT study. Eur Child Adolesc Psychiatry 2015; 24:503-15. [PMID: 25138145 DOI: 10.1007/s00787-014-0601-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study was to assess the prevalence of chronic multisite pain with high disability in relation to emotional or behavioral problems and resilience factors in adolescence. A second aim was to investigate if resilience factors could attenuate the associations between psychiatric symptoms and chronic multisite pain. The study was based on a large cross-sectional study carried out in Norway between 2006 and 2008 and included 7,070 adolescents aged 13-19 years. Chronic multisite pain was defined as pain at least once a week during the last 3 months, scoring high on a disability index, and occurring in three or more locations. Chronic multisite pain was prevalent among adolescents with high scores (>85%) for anxiety/depression, social anxiety, conduct or attention problems (22.8-31.0 for girls, 8.8-19.0% for boys). Several coexistent psychiatric symptoms increased the prevalence of chronic multisite pain for both girls and boys. Resilience factors, including high self-esteem, seldom feeling lonely, and high scores for family cohesion or social competence, were associated with a lower prevalence and markedly attenuated the association between psychiatric symptoms and chronic multisite pain. Psychiatrists should be careful to assess and treat comorbid chronic pain in adolescents with emotional or behavioral problems.
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27
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Stumpf A, Ständer S, Warlich B, Fritz F, Bruland P, Pfleiderer B, Heuft G, Schneider G. Relations between the characteristics and psychological comorbidities of chronic pruritus differ between men and women: women are more anxious than men. Br J Dermatol 2015; 172:1323-8. [PMID: 25350351 DOI: 10.1111/bjd.13492] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although sex and gender are becoming more important in diagnostics and therapy, there is still little knowledge about sex-specific differences in chronic pruritus (CP). OBJECTIVES To compare, taking into consideration the characteristics of pruritus, sex-specific differences in psychological symptoms in patients with CP. METHODS Sociodemographic data, data on the clinical characteristics of the skin and CP were documented over a 1-year period in all patients attending the Competence Center Chronic Pruritus of the University Hospital Münster for the first time. All patients completed the Hospital Anxiety and Depression Scale. Student's t-tests for independent study groups and linear regression analyses were applied. RESULTS A total of 619 patients (278 men, 341 women) were included in the analysis. Women were more anxious than men, but were not more depressed. A linear regression analysis indicated that depression and anxiety scores in women were related to the average intensity of pruritus during the previous 4 weeks and to a more generalized pruritus at the beginning of CP; older age in women also correlated with the scores on the depression subscale. Interestingly, the associations were different in men: scores on the depression scale were associated with the diagnosis of CP pruritus with multiple scratch lesions. CONCLUSIONS There are sex-specific differences in the relationship between the psychological symptoms and clinical characteristics of CP; higher anxiety scores were achieved by women. Whether psychological symptoms can be reversed when CP and scratch lesions improve is an issue that needs further exploration.
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Affiliation(s)
- A Stumpf
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.,Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Ständer
- Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Dermatology, University Hospital Münster, Münster, Germany
| | - B Warlich
- Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Dermatology, University Hospital Münster, Münster, Germany
| | - F Fritz
- Department of Medical Informatics, University Hospital Münster, Münster, Germany
| | - P Bruland
- Department of Medical Informatics, University Hospital Münster, Münster, Germany
| | - B Pfleiderer
- Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - G Heuft
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.,Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - G Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.,Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany
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28
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Abstract
Primary headaches among children and adolescents have a substantial impact on quality of life, daily activities, social interaction, and school performance in combination with psychopathological symptoms. The main purpose of the present paper is to summarize clinical and epidemiological evidence for psychiatric comorbidity among children and adolescents with headaches, to describe how evidence in headache research suggest different pathways involved in the development and maintenance of these comorbid conditions, and finally suggest some elements professionals may find helpful to assess the scope of complaints, related functional impairment, and potential precipitating factors in planning of more targeted treatments.
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Affiliation(s)
- Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, P.B. 181, Nydalen 0409, Oslo, Norway,
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Differential associations of specific depressive and anxiety disorders with somatic symptoms. J Psychosom Res 2015; 78:116-22. [PMID: 25524436 DOI: 10.1016/j.jpsychores.2014.11.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/07/2014] [Accepted: 11/09/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Previous studies have shown that depressive and anxiety disorders are strongly related to somatic symptoms, but much is unclear about the specificity of this association. This study examines the associations of specific depressive and anxiety disorders with somatic symptoms, and whether these associations are independent of comorbid depressive and anxiety disorders. METHODS Cross-sectional data were derived from The Netherlands Study of Depression and Anxiety (NESDA). A total of 2008 persons (mean age: 41.6 years, 64.9% women) were included, consisting of 1367 patients with a past-month DSM-diagnosis (established with the Composite International Diagnostic Interview [CIDI]) of depressive disorder (major depressive disorder, dysthymic disorder) and/or anxiety disorder (generalized anxiety disorder, social phobia, panic disorder, agoraphobia), and 641 controls. Somatic symptoms were assessed with the somatization scale of the Four-Dimensional Symptom Questionnaire (4DSQ), and included cardiopulmonary, musculoskeletal, gastrointestinal, and general symptoms. Analyses were adjusted for covariates such as chronic somatic diseases, sociodemographics, and lifestyle factors. RESULTS All clusters of somatic symptoms were more prevalent in patients with depressive and/or anxiety disorders than in controls (all p<.001). Multivariable logistic regression analyses showed that all types of depressive and anxiety disorders were independently related to somatic symptoms, except for dysthymic disorder. Major depressive disorder showed the strongest associations. Associations remained similar after adjustment for covariates. CONCLUSION This study demonstrated that depressive and anxiety disorders show strong and partly differential associations with somatic symptoms. Future research should investigate whether an adequate consideration and treatment of somatic symptoms in depressed and/or anxious patients improve treatment outcomes.
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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.
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Affiliation(s)
- Brit A Blaauw
- Department of Neurology, Vestfold Hospital, Tønsberg, Norway.
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Lin CH, Yen YC, Chen MC, Chen CC. Depression and pain impair daily functioning and quality of life in patients with major depressive disorder. J Affect Disord 2014; 166:173-8. [PMID: 25012428 DOI: 10.1016/j.jad.2014.03.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Depression and pain frequently occur together. The objective of this study was to investigate the effects of depression and pain on the impairment of daily functioning and quality of life (QOL) of depressed patients. METHODS We enrolled 131 acutely ill inpatients with major depressive disorder. Depression, pain, and daily functioning were assessed using the 17-item Hamilton Depression Rating Scale, the Short-Form 36 (SF-36) Body Pain Index, and the Work and Social Adjustment Scale. Health-related QOL was assessed using three primary domains of the SF-36: social functioning, vitality, and general health perceptions. Pearson׳s correlation and structural equation modeling were used to examine relationships among the study variables. Five models were proposed. RESULTS In all, 129 patients completed all the measures. Model 5, both depression and pain impaired daily functioning and QOL, was the most fitted structural equation model (χ(2)=9.2, df=8, p=0.33, GFI=0.98, AGFI=0.94, TLI=0.99, CFI=0.99, RMSEA=0.03). The correlation between pain and depression was weak (r=-0.27, z=-2.95, p=0.003). LIMITATION This was a cross-sectional study with a small sample size. CONCLUSION Depression and pain exert a direct influence on the impairment of daily functioning and QOL of depressed patients; this impairment could be expected regardless of increased pain, depression, or both pain and depression. Pain had a somewhat separate entity from depression.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Chieh Yen
- Department of Psychiatry, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ming-Chao Chen
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Chung Chen
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Berry JKM, Drummond PD. Does attachment anxiety increase vulnerability to headache? J Psychosom Res 2014; 76:113-20. [PMID: 24439686 DOI: 10.1016/j.jpsychores.2013.11.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Attachment-related anxiety and avoidance are potentially important aspects of pain experience and management, but have not been investigated in episodic headache sufferers or in relation to experimentally-evoked headache. OBJECTIVE To determine whether adult insecure attachment styles were associated with sensitivity to pain or headache before, during or after stressful mental arithmetic in an episodic migraine or tension-type headache (T-TH) sample. METHODS Thirty-eight participants with episodic migraine, 28 with episodic T-TH and 20 headache-free participants intermittently received a mild electric shock to the forehead before, during and after stressful mental arithmetic. RESULTS A preoccupied attachment style and attachment anxiety, but not attachment avoidance, were associated with forehead pain and the intensity of headache before and after, but not during stressful mental arithmetic. These relationships were independent of Five Factor Model personality traits. Neither attachment anxiety nor avoidance was associated with episodic migraine or T-TH. CONCLUSIONS Anxiously attached individuals may express greater pain or show a stronger attentional bias toward painful sensations than securely attached individuals. However, distraction during psychological stress may override this attentional bias.
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Affiliation(s)
- Juanita K M Berry
- School of Psychology, Murdoch University, Perth, Western Australia, Australia
| | - Peter D Drummond
- School of Psychology, Murdoch University, Perth, Western Australia, Australia.
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Paschoal JKSF, Lin J, Pinho RS, Andreoni S, Minett TSC, Vitalle MSDS, Fisberg M, Peres MFP, Vilanova LCP, Masruha MR. Psychiatric symptoms may contribute to poor quality of life in adolescents with migraine. Pediatr Int 2013; 55:741-7. [PMID: 23829487 DOI: 10.1111/ped.12178] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 06/23/2013] [Accepted: 06/28/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of migraine on quality of life (QOL) can be aggravated by other comorbid factors. The aim of the present study was to assess the differences in the QOL of adolescents with chronic migraine, episodic migraine, and healthy adolescents, and whether the differences in QOL among the diagnostic groups were associated with the presence of self-reported psychiatric symptoms, such as depression and anxiety. METHODS A total of 157 adolescents (aged 15-19 years old) were included in the study. Fifty patients had episodic migraine, 56 patients suffered from chronic migraine, and 51 healthy adolescents were controls. All of the participants responded to a detailed headache questionnaire, the Medical Outcomes Trust 36-Item Short-form Health Survey, the State-Trait Anxiety Inventory and the Beck Depression Inventory. RESULTS Chronic migraine patients showed a significantly lower QOL than the control subjects in five dimensions of the Medical Outcomes Trust 36-Item Short-form Health Survey, and lower QOL than the episodic migraine patients in four dimensions. High levels of self-reported depressive symptoms were associated with lower QOL in five dimensions and high levels of self-reported anxiety were associated with lower QOL in four dimensions. CONCLUSIONS The QOL of adolescent migraine sufferers may be aggravated not only by migraine but also by other factors, such as anxiety and depressive symptoms, which may contribute to the poor QOL in adolescents suffering from migraine.
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Karlson CW, Litzenburg CC, Sampilo ML, Rapoff MA, Connelly M, Bickel JL, Hershey AD, Powers SW. Relationship between daily mood and migraine in children. Headache 2013; 53:1624-34. [PMID: 24102349 DOI: 10.1111/head.12215] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Retrospective and cross-sectional studies have suggested a bidirectional relationship between migraine and mood disturbance. OBJECTIVE The present prospective daily diary study examined the prevalence and temporal associations between migraine and daily mood, mood and next-day headache, and headache and next-day mood. METHODS Sixty-nine children (50 females, 19 males) between the ages of 7 and 12 years and their parents attending neurology clinic appointments and having a diagnosis of migraine as defined by International Headache Classification 2nd edition criteria completed measures on the quality of life, headache disability, child emotions, and child behaviors. Children and parents then recorded children's headache occurrence, headache duration, headache severity, mood, daily hassles, and medication use on paper diaries once a day for 2 consecutive weeks. "Mood" was defined using the Facial Affective Scale, which is a visual representation of negative and positive affect. Data were analyzed using multilevel models. RESULTS Controlling for age, sex, quality of life, headache disability, and medication use, worse mood was associated with same-day occurrence, longer duration, and more severe headache in both child and parent report. Today's mood was not consistently associated with next-day headache, and today's headache was not associated with next-day mood in either child or parent report. CONCLUSIONS Results of this study lend support to a complex relationship between mood and headache in children with migraine. More research is needed to further elucidate the temporal nature of this relationship within a given day and over an extended period of time.
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Affiliation(s)
- Cynthia W Karlson
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
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Ravid S, Gordon S, Schiff A, Shahar E. Headache in children: young age at onset does not imply a harmful etiology or predict a harsh headache disability. J Child Neurol 2013; 28:857-62. [PMID: 22914375 DOI: 10.1177/0883073812452788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this retrospective study was to compare headache etiology, type, and burden and the learning and behavioral profile in children with early-onset (under 6 years) and late-onset (8-12 years) headaches. The study included 133 patients, 35 in the early-onset group and 98 in the late-onset group. Headache diagnosis was based on International Classification of Headache Disorders -II (ICHD-II) criteria. Learning profile and behavioral problems were assessed by parental reports. Tension headache was the most common diagnosis in the early-onset headache group (51.4%). No significant differences were found between the age groups with regard to headache etiology, disability, abnormal neuroimaging results, school performance, or attention problems. Nevertheless, the early-onset group patients had a significantly higher prevalence of behavioral problems: 25.7% versus 11.2% (P < .02). The authors suggest that early age of headache onset does not imply a harmful etiology or a relentless headache disability or burden.
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Affiliation(s)
- Sarit Ravid
- Department of Pediatrics, Meyer Children's Hospital, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Lewandowski Holley A, Law EF, Zhou C, Murphy L, Clarke G, Palermo TM. Reciprocal longitudinal associations between pain and depressive symptoms in adolescents. Eur J Pain 2012; 17:1058-67. [PMID: 23280775 DOI: 10.1002/j.1532-2149.2012.00272.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Elevated depressive symptoms are common in youth with chronic pain, and pain symptoms are frequent in adolescents with depressive disorders. While studies have identified concurrent associations between pain and depression over time in youth, it is unclear how change in one symptom impacts change in the other symptom. METHODS This three-time point 12-month longitudinal study examined reciprocal associations among pain and depression in a clinical sample of adolescents (12-18) diagnosed with chronic pain (n = 55) or a depressive disorder (n = 40). Mixed-effects multivariate models were used to test if changes over a preceding time interval predicted symptom severity at subsequent time points. Study group, age, sex, race, baseline pain intensity and baseline depressive symptoms were included as covariates. RESULTS Generalized estimating equations revealed that pain and depressive symptoms were significantly associated over time (β = 1.54; p < 0.001). As hypothesized, changes in pain were associated with subsequent depressive symptoms (β = 1.16; p < 0.001). Conversely, changes in depressive symptoms predicted subsequent pain (β = 0.026; p < 0.05), but with a weaker association. In the model predicting pain, an interaction between depressive symptoms and study group emerged (β = -0.02; p < 0.05), with change in depressive symptoms having the greatest impact on pain in the depressed sample. CONCLUSIONS Findings extend previous adult research to an adolescent sample showing changes in pain intensity are predictive of subsequent depressive symptoms. In comparison to adult data, changes in depressive symptoms had less impact on subsequent pain in youth. Future research can examine how targeting persistent pain may also aid the treatment of depressive symptoms in adolescents.
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Affiliation(s)
- A Lewandowski Holley
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, 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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Gaßmann J, Barke A, van Gessel H, Kröner-Herwig B. Sex-specific predictor analyses for the incidence of recurrent headaches in German schoolchildren. PSYCHO-SOCIAL MEDICINE 2012; 9:Doc03. [PMID: 22879857 PMCID: PMC3413875 DOI: 10.3205/psm000081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: The aim of the present study was to identify psychosocial risk factors for the incidence of recurrent headache (HA) in children/adolescents (8–15 years). Method: In 2003 (Wave 1) a representative, population-based sample of 8800 parents was mailed a questionnaire. Those who took part were asked to participate again one year later (Wave 2). Of the parents originally contacted, 47.3% participated in both surveys. Potential risk factors concerning the areas ‘school’ and ‘emotional and behavioural problems’ were collected in Wave 1. Binary logistic regression analyses were performed to assess their predictive value for HA in Wave 2. Results: Univariable regression analyses showed that for boys and girls most of the predictor variables influenced the incidence of recurrent HA, but only to a very low extent. When all variables were assessed jointly in a multivariable model, these factors lost their predictive power for boys. For girls, ‘academic problems’ and ‘dysfunctional stress coping’ were shown to increase the chance for the incidence of recurrent HA. Discussion: In contrast to previous findings, school-related factors and emotional and behavioural problems failed to predict HA in boys, and only two factors appeared relevant with regard to girls. This might be due to the strict unidirectional design, which focussed exclusively on the incidence of HA.
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Affiliation(s)
- Jennifer Gaßmann
- Georg-Elias-Müller-Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Georg-August-University Göttingen, Germany
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Psychosocial determinants of headache, abdominal pain, and sleep problems in a community sample of Finnish adolescents. Eur Child Adolesc Psychiatry 2012; 21:301-13. [PMID: 22350133 DOI: 10.1007/s00787-012-0261-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
The aims of this study were to examine the prevalence, co-occurrence, and psychosocial determinants of self-perceived headache, abdominal pain, and sleep problems among adolescents. The adolescents from two cities in Finland (n = 2,215, 90.9% of the target population) attending 7th and 9th grade (age range 13-18 years) participated in the cross-sectional survey inquiring about frequency of headache, abdominal pain, sleep problems, and psychosocial difficulties. The 6-month prevalence of weekly headache was 13%, abdominal pain 6%, and sleep problems 27%. All three symptoms were strongly associated with each other. Of the adolescents suffering from one symptom, 32% reported one co-occurring symptom and 17% two co-occurring symptoms. In the multivariate analysis, female gender, experience of psychological difficulties, emotional symptoms, smoking, victimization, and feeling not cared about by teachers were independently associated with all the individual symptoms, as well as an increasing number of symptoms. Sleep problems were associated with older age and peer and alcohol problems. Abdominal pain was associated with conduct problems, and both headache and abdominal pain were linked with immigration background. An increasing number of symptoms was associated with older age, having a chronic illness, and conduct and alcohol problems. Adolescents' headache, abdominal pain and sleep problems were common and often co-occurred. An increasing frequency of each symptom and number of symptoms were associated with psychosocial factors in a similar way. Screening for psychiatric symptoms, substance use, victimization and difficulties with teachers should be included in the assessment of adolescents who suffer from recurrent headache, abdominal pain or sleep problems.
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Campo JV. Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice. J Child Psychol Psychiatry 2012; 53:575-92. [PMID: 22404290 DOI: 10.1111/j.1469-7610.2012.02535.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Medically unexplained physical symptoms, commonly referred to as functional somatic symptoms (FSS), are common in pediatric medical settings and associated with suffering, impairment, and medical help seeking. The association of pediatric FSS with anxiety and depressive symptoms and disorders across the life span is reviewed. METHOD Review and critique of controlled studies examining cross-sectional and longitudinal associations of FSS with anxiety and depressive symptoms and disorders in community-based and clinical samples of children and adolescents. RESULTS FSS are consistently associated cross-sectionally with anxiety and depressive symptoms and disorders in childhood and adolescence, and the likelihood of associated anxiety and depression increases with the number of reported FSS. The presence of one or more FSS early in life is associated with an increased likelihood of multiple FSS and anxiety and depressive symptoms and disorders later in life, and anxiety and depressive symptoms and disorders in childhood are associated with subsequent multiple FSS. CONCLUSION Strong associations between FSS, anxiety, and depression across the life span suggest the need to reconsider existing nosology and reconceptualize symptomatic relationships. Large, population-based longitudinal studies of FSS, anxiety, and depressive symptoms and disorders are needed to establish temporal relationships between the various symptoms and conditions.
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Affiliation(s)
- John V Campo
- Department of Psychiatry, Professor and chair, The Ohio State University, Columbus, Ohio, USA
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Pain at age eight as a predictor of antidepressant medication use by age 24: findings from the Finnish nationwide 1981 birth cohort study. J Affect Disord 2012; 138:153-9. [PMID: 22314262 DOI: 10.1016/j.jad.2012.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 01/03/2012] [Accepted: 01/03/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The existing knowledge about long-term psychosocial consequences of childhood pain is scarce. The current study investigated childhood pain symptoms as potential risk factors for antidepressant use in adolescence and early adulthood. METHODS A representative sample of eight-year-old children (n=6017) and their parents were asked about the prevalence of the child's headache, abdominal pain, and unspecified pain symptoms. The associations with antidepressant purchases by age 24, based on the nationwide prescription register, were analyzed separately for each symptom and each reporter. Sex, parental educational level, and child-, parent- and teacher-reported child's psychiatric symptoms at baseline were included as confounding variables. RESULTS In the sex-adjusted model, the child's own report of headache and other pains, and the parents' report of their child's abdominal pain, predicted antidepressant purchases. When confounding variables were included in the final model, only the child's own report of headache predicted antidepressant use with a dose-response relationship. The hazard ratios and 95% confidence intervals for frequent and for almost daily headache were 1.6 (1.3-2.0) and 2.1 (1.5-2.9), respectively, in the sex-adjusted model, and 1.5 (1.2-1.8) and 1.7 (1.2-2.5) in the final model. LIMITATIONS The assessment of each pain symptom was based on one question for each reporter. The specific indications for the described medication could not be defined. CONCLUSIONS Health care professionals should also ask children themselves about the pain symptoms. They should be aware that children with pain are at increased risk of suffering later from conditions that require antidepressant treatment.
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Murray CB, Murphy LK, Palermo TM, Clarke GM. Pain and sleep-wake disturbances in adolescents with depressive disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2012; 41:482-90. [PMID: 22420746 DOI: 10.1080/15374416.2012.658613] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aims of this study were to (a) assess and compare sleep disturbances (including daytime and nighttime sleep patterns) in adolescents with depressive disorders and healthy peers, (b) examine the prevalence of pain in adolescents with depressive disorders and healthy peers, and (c) examine pubertal development, pain intensity, and depressive symptom severity as predictors of sleep disturbance. One hundred six adolescents (46 depressed, 60 healthy), 12 to 18 years (M = 15.10 years; 67% female; 77% Caucasian) completed subjective measures of sleep, presleep arousal, fatigue, and pain. Participants also underwent 10 days of actigraphic monitoring to assess nighttime and daytime sleep duration, sleep efficiency, and wake after sleep onset. Results indicated that youth with depression exhibited greater sleep disturbances on subjective and actigraphic sleep variables than healthy controls. Depressed youth also reported more frequent and severe pain than healthy youth. Linear regression analysis indicated that pain intensity and depressive symptoms predicted worse sleep quality across groups. The interaction term was also significant, such that adolescents with high levels of depressive symptoms had poor sleep quality when pain intensity levels were high. These results indicate that sleep is important to assess in youth with depression, and that pain may be an important target for sleep intervention in this population.
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Affiliation(s)
- Caitlin B Murray
- Psychology Department, Loyola University Chicago, 1032 W. Sheridan Road, Chicago, IL 60660, USA.
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Larsson B, Sund AM. Emotional/behavioural, social correlates and one-year predictors of frequent pains among early adolescents: Influences of pain characteristics. Eur J Pain 2012; 11:57-65. [PMID: 16480907 DOI: 10.1016/j.ejpain.2005.12.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Revised: 12/19/2005] [Accepted: 12/27/2005] [Indexed: 12/22/2022]
Abstract
In a one-year longitudinal study, emotional/behavioural correlates and predictors of four common pain complaints (headaches, stomach, back and limb pain), were examined in a representative school sample of 2360 adolescents aged 12- to 15-years. At first assessment, 18.3% reported being bothered by a frequent pain (at least once a week) and 40% of the pain sufferers had two or more pain locations, more commonly reported by girls. Subjects having any of the four frequent pains reported having fewer friends and were more often absent from school. Frequency and number of reported pains among adolescents were positively related to levels of internalising and externalising problems. These latter problems were consistently and significantly higher among adolescents with frequent back and limb pains, however, when coexistence of another frequent pain was controlled, differences were small. Number of pains at the one-year follow-up was significantly predicted by frequent back pain and headache, depressive symptoms scores, somatic complaints (other than pain), number of friends and reduced leisure time activities during the follow-up period. Frequent back pain and depressive symptoms also predicted multiple frequent pains (vs single frequent pain) at the follow-up as did recent parental divorce. It is concluded that various emotional and behavioural problems, and which are commonly regarded as being specifically related to pain type or location among adolescents, depend rather on frequency and coexistence of multiple frequent pains. Assessment of adolescents with frequent and multiple pains should, therefore, include broad screening of internalising as well as externalising problems as well as various aspects of impairment.
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Affiliation(s)
- Bo Larsson
- Department of Neuroscience, Regional Centre for Child & Adolescent Mental Health, The Norwegian University of Science and Technology (NTNU), NO-7489 Trondheim, Norway.
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Goal frustration, coping and well-being in the context of adolescent headache: A self-regulation approach. Eur J Pain 2012; 13:977-84. [DOI: 10.1016/j.ejpain.2008.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 11/08/2008] [Accepted: 11/16/2008] [Indexed: 11/18/2022]
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Pitrou I, Shojaei T, Chan-Chee C, Wazana A, Boyd A, Kovess-Masféty V. The associations between headaches and psychopathology: a survey in school children. Headache 2011; 50:1537-48. [PMID: 21198562 DOI: 10.1111/j.1526-4610.2010.01781.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Headaches are common in childhood and significantly impact children's quality of life. On the contrary to the adolescent and adult population, there are few data on the associations between headaches and psychopathology in young children. OBJECTIVE The aim of this study was to examine the relationships between child headaches, emotional and behavioral difficulties in children aged 6-11 years old. METHODS A cross-sectional survey was conducted in 2004 in 100 primary schools from a large French region, with 2341 children aged 6-11 years old randomly selected. Child headache status, comorbid physical conditions, and socioeconomic characteristics were collected in parent-administered questionnaires. Child psychopathology outcomes were assessed using child- and parent-reported standardized instruments: respectively, the Dominic Interactive and the Strengths and the Difficulties Questionnaire. Associations were estimated using logistic regression models. RESULTS Response rates to the parent questionnaire and the Dominic Interactive were 57.4% and 95.1%, respectively. The final sample size was 1308 children. Eleven percent of the children already experienced frequent headaches in their lifetime, with no difference by age or gender. Headaches were associated with parent-reported emotional problems (OR=1.76; 95% CI: 1.03-3.01) and self-reported general anxiety disorder (OR=1.99; 1.13-3.52). Comorbid physical conditions ≥2 appeared as an independent factor significantly associated with headaches (OR =1.75; 95% CI: 1.13-2.73). Inversely, low parental punitive behaviors were less frequently associated with headaches (OR=0.41; 95% CI: 0.18-0.94). CONCLUSION Our results suggest some associations between headaches, emotional disorders, and comorbid physical conditions in young children aged 6-11 years old. Those results should be considered in the treatment approaches of childhood headaches and from the etiological aspect.
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Affiliation(s)
- Isabelle Pitrou
- EA 4069 Paris Descartes University, Ecole des Hautes Etudes de Santé Publique (EHESP), Paris, France
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Massey EK, Garnefski N, Gebhardt WA, van der Leeden R. A daily diary study on the independent and interactive effects of headache and self-regulatory factors on daily affect among adolescents. Br J Health Psychol 2011; 16:288-99. [PMID: 21489057 DOI: 10.1348/135910710x500828] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The relationship between recurrent headache and reduced psychological well-being among adolescents has been well documented. Evidence also suggests that headache is associated with greater impediment to successful goal pursuits, which in turn is related to reduced well-being. The aim of this study was to investigate both the independent and interactive effects of headache and self-regulatory processes on daily positive and negative affect. DESIGN AND METHODS In order to be able to investigate both concurrent and prospective relationships a daily diary design was employed. Independent variables were headache occurrence, daily goal frustration, and strategies to cope with these setbacks. Dependent variables were daily negative and positive affect. Eighty-nine adolescents from the general population aged 13-21 completed an on-line diary for 3 weeks. Data were analysed using multi-level modelling. RESULTS Negative affect was related to same day headache occurrence, high daily goal frustration, rumination, catastrophizing, other blame, and low coping efficacy beliefs. Furthermore, in the context of headache, coping efficacy appears to buffer the effects of goal frustration on same day negative affect. Negative affect on the next day was predicted by high daily goal frustration, rumination, catastrophizing, and low coping efficacy. In contrast, positive affect was related to no same day headache occurrence; low daily goal frustration, and high acceptance, positive refocusing, and coping efficacy. Positive affect on the following day was related to low daily goal frustration, rumination, and high positive refocusing. CONCLUSIONS Daily goal frustration and cognitive coping strategies may provide important targets for interventions aimed at adolescent with reduced well-being due to headache.
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Affiliation(s)
- E K Massey
- Clinical, Health and Neuropychology Unit, Leiden University Institute for Psychological Research, Leiden University, Rotterdam, The Netherlands.
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Leo RJ, Srinivasan SP, Parekh S. The Role of the Mental Health Practitioner in the Assessment and Treatment of Child and Adolescent Chronic Pain. Child Adolesc Ment Health 2011; 16:2-8. [PMID: 32847226 DOI: 10.1111/j.1475-3588.2010.00578.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronic and recurrent benign pain complaints are common among children and adolescents. Although many young persons with chronic pain adapt well, a small, but significant, proportion experience marked functional deficits. Pain can produce life disruptions, e.g. impeding activities and maturation, and interferes with family functioning. Conventional medically-based approaches have been inadequate in addressing chronic pain and its sequelae. Instead, effective management requires an interdisciplinary approach involving paediatricians and mental health practitioners working collaboratively to treat psychiatric comorbidities, enhance the patient's functional adaptation, restore the child or adolescent's maturational and social capabilities and reduce family disruptions.
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Affiliation(s)
- Raphael J Leo
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Erie County Medical Center, 462 Grider Street, Buffalo, New York 14215, USA. E-mail:
| | - Shiva Prakash Srinivasan
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Erie County Medical Center, 462 Grider Street, Buffalo, New York 14215, USA. E-mail:
| | - Shrenik Parekh
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Erie County Medical Center, 462 Grider Street, Buffalo, New York 14215, USA. E-mail:
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Affiliation(s)
- Teresa Paiva
- Institute of Molecular Medicine, Medical Faculty of Lisbon, Lisbon, Portugal.
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Morning headaches, daytime functioning and sleep problems – a population-based controlled study. Wien Klin Wochenschr 2010; 122:579-83. [DOI: 10.1007/s00508-010-1464-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 09/07/2010] [Indexed: 11/25/2022]
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Abstract
Recurrent headaches in children are most often migraines and are based in a genetic predisposition with a low headache threshold. As with any pain experience, there is a large emotional component associated with an attack of migraines that grows in amplitude as the headaches become more frequent and resistant to medicine, sleep, or other agents that used to work. Childhood headaches are especially complicated for 3 reasons: (1) the parents' fear (communicated to the child that serious medical pathology underlies the head pain), (2) the lack of evidence-based pharmacologic treatment, and (3) the belief that these headaches are largely psychological. This article addresses the mystery surrounding childhood headaches by delving into the influence of school, friends, and family; the impact of divorce; the coping skills required for a child to manage a migrainous nervous system; the potential secondary gain from headaches; psychiatric comorbidities and how to treat them; and the role of psychological intervention.
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