Thursday, October 29, 2015

Childhood migraine comorbidities

Children and adolescents with migraine are more than three times as likely as those without headaches to have a mood disorder, such as depression, and almost three times more likely to have other neurologic conditions, such as epilepsy, a new study shows.

The overlap between headache and mood disorders was particularly "striking" and highlights the need for neurologists to screen for such disorders, according to lead study author, Terranum Lateef, MD, assistant professor, George Washington School of Medicine, who is also affiliated with Children's National Health System, Washington, DC.

"Doctors should be doing a strong, thorough evaluation to assess for mood disorders," said Dr Lateef. "These are young kids and if we are seeing that this migraine population is also at risk for having mental health problems, maybe we should be diagnosing this early. I don't think anybody needs to be reminded of how severe the consequences are if we don't treat mental illness in a timely fashion."

Dr Lateef presented her research here at the 44th Child Neurology Society (CNS) Annual Meeting.

The study sample included 9014 young people aged 8 to 21 years from the Philadelphia Neuro-developmental Cohort. They were a subset of children presenting to the Children's Hospital of Philadelphia healthcare network for anything from broken bones to a heart disorder, said Dr Lateef.

The study found that children with any headache, and specifically those with migraine, reported higher rates of other neurologic conditions (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.9 - 4.1).  Epilepsy was "a big one," said Dr Lateef, adding that the connection between headache and epilepsy could be causal — for example, seizure medications leading to headaches — or the two conditions could share a common cause.

Tic disorders were also relatively common among pediatric patients with headaches...

Kids with headache had more developmental disorders, too (OR, 1.6; 95% CI, 1.3 - 4.1). This includes the neurodevelopmental attention-deficit/hyperactivity disorder...

Children with migraine were also more than three times as likely to have a mood disorder (OR, 3.5; 95% CI, 2.4 - 5.2) and twice as likely to have anxiety (OR, 2.0; 95% CI, 1.3 - 3.0) compared with young nonmigraineurs.

This overlap was "unique to migraine," Dr Lateef stressed. "When you look at those with nonspecific headache, they were not more likely to be anxious or depressed. If the headache was purely situational — meaning 'I have a bad mood and therefore I have headache' — we should see it for all headaches, but it's really specific to migraine. That raises the question of whether it's an inflammatory pathophysiology for both."

She stressed that it's not just psychiatrists who encounter patients with mood disorders and that neurologists and primary care doctors should also look for these conditions.
Cardiac problems were another common comorbidity among kids with headache (OR, 2.3; 95% CI, 1.3 - 4.1). The researchers couldn't "parse out" the different cardiac disorders, such as structural problems or valvular disease, but Dr Lateef pointed out that adults, particularly women, with migraine with aura have a higher risk for stroke.

"That raises the question of what's wrong with the blood vessels, the vascular system, in these folks," she said. "It we are finding this even in young kids, that tells us that this is not just somebody who smokes or drinks or has high blood pressure; there is clearly something about a migraineur's vasculature that is different."

The researchers also found that children with headaches were more at risk for hematologic conditions (OR, 2.3; 95% CI, 1.2 - 2.3). Here again it was impossible to determine the cause of the connection, but it could be related to platelets, which, once more, raises the possibility of inflammatory-related pathways, said Dr Lateef.

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