Friday, January 22, 2016

Psychopathology and quality of life in childhood migraine

 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 Jan 12.



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.


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.


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.


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.
Courtesy of:


  1. Amouroux R, Rousseau-Salvador C. [Anxiety and depression in children and adolescents with migraine: a review of the literature]. Encephale. 2008 Oct;34(5):504-10.



    The authors review the literature on anxiety and depression in children and adolescents who experience migraine headaches. For over a century, clinicians and researchers have noticed potential links between migraine and certain psychopathological traits. More recently, rigorous methodological studies have confirmed some of those links. For example, several reviews have shown a strong comorbidity in adults between migraine, major depression and certain anxiety disorders. As for children and adolescents, no recent work has thoroughly reviewed the literature specifically on the topic of migraine, anxiety, and depression.


    For the purposes of this study, research published between January 1980 and January 2007 was examined. In order to be included in the review, studies had to specify the diagnostic criteria used to indicate migraine headaches and also use validated measures for anxiety and depression. Of the eleven remaining articles, ten used a control group matched for age and sex. Only three of the studies used a representative sample of the general population. Carrying out a meta-analysis was not possible due to the dearth of articles and the wide variety of methodologies applied. The studies included in this review do not provide conclusive findings for the comorbidity of migraine, anxiety and depression in children. (continued)

  2. (continued)RESULTS:

    The majority of the studies with clinical populations show slightly higher scores on at least one of the anxiety or depression scales in the migraine group as compared to the control group. However, in all eleven studies, the average score on the anxiety and depression scales obtained by children with migraine did not reach a pathological level, according to the norms established by the validated scales. Findings point to above average levels of anxiety or depression, rather than diagnosed psychopathologies. Therefore, certain authors use the term "sub-clinical." One study of a clinical population, paired dimensional assessment with tests and categorical assessment, using diagnostic interviews. In this particular study, children with highly predictive anxiety or depression scores were interviewed by a psychiatrist or psychologist, in order to confirm or deny a diagnosis. No categorical difference was found. Moreover, none of the three studies carried out in the general population revealed differences between the anxiety and depression scores in children with migraine as opposed to children in the control group. The difference in results from studies in the general population and clinical populations can most likely be explained by a recruitment bias. Studies conducted with clinical populations recruit subjects from specialised medical consultations for children and adolescents with migraine, who are probably not representative of the general population. These results contradict those found in the adult population.


    More studies are needed to better clarify the links between anxiety, depression, and migraine in children, adolescents and adults. To ensure the validity of future studies, the following remarks should be taken into account. The distinction between headache and migraine is not always clear, even when ICHD criteria are used. The children considered to have migraines often have a variety of diagnoses. Future studies should only use the ICHD 2nd edition criteria. Children suffering from migraine are almost always recruited from specialized headache centres in hospitals. This is a very specific population and probably not representative of children with migraine in the general population. In the future, researchers should do their best to avoid this recruitment bias. The questionnaires used in these studies often contain questions related to migraine symptoms such as headache, nausea, vomiting, etc. Several authors have therefore questioned the validity of results from these questionnaires with migraine patients.


    Questionnaires created specifically for a research project, or containing vague terminology, such as "psychosocial disorders", should never be used. Future studies should rely on assessment tools validated for the specific population.

  3. Smith MS, Martin-Herz SP, Womack WM, Marsigan JL. Comparative study of anxiety, depression, somatization, functional disability, and illness attribution in adolescents with chronic fatigue or migraine. Pediatrics. 2003 Apr;111(4 Pt 1):e376-81.



    To compare adolescents with migraine, unexplained profound chronic fatigue of >6 months duration, and normal school controls on measures of anxiety, depression, somatization, functional disability, and illness attribution.


    Adolescents referred to Children's Hospital and Regional Medical Center for behavioral treatment of migraine (n = 179) or evaluation of chronic fatigue (n = 97) were compared with a group of healthy controls of similar age and sex from a middle school (n = 32). Subjects completed the Spielberger State-Trait Anxiety Inventory-Trait Form, the Children's Depression Inventory, the Childhood Somatization Inventory, and estimated the number of school days missed in the past 6 months because of illness. Migraine and fatigued subjects completed an illness attribution questionnaire.


    Subjects in the 3 groups were 56% to 70% female and ranged from 11 years old to 18 years old with a mean age of 14.0 +/- 2.0. Forty-six of the 97 chronically fatigued adolescents met 1994 Centers for Disease Control and Prevention (CDC) criteria for chronic fatigue syndrome (CDC-CFS), while 51 had idiopathic chronic fatigue syndrome (I-CFS) that did not meet full CDC criteria. Adolescents with migraine had significantly higher anxiety scores than those with I-CFS or controls and higher somatization scores than controls. Adolescents with CDC-CFS had significantly higher anxiety scores than those with I-CFS or controls, and higher depression and somatization scores than all other groups. There were significant differences between all groups for school days missed with CDC-CFS more than I-CFS more than migraine more than controls. Parents of adolescents with unexplained I-CFS had significantly lower attribution scores relating illness to possible psychological or stress factors than parents of adolescents with CDC-CFS or migraine.


    Adolescents referred to an academic center for evaluation of unexplained chronic fatigue had greater rates of school absenteeism than adolescents with migraine or healthy controls. Those meeting CDC-CFS criteria had higher anxiety scores than controls and higher depression and somatization scores than migraineurs or controls. Parents of adolescents with I-CFS were less likely to endorse psychological factors as possibly contributing to their symptoms than parents of adolescents with CDC-CFS or migraine.