Anxiety, Depression, and Body Weight in Children and Adolescents With Migraine

Abstract

Background: There is a lack of studies that explore the possible association between body weight, psychological symptoms, and migraine severity in pediatric populations. The purpose of the study was to explore: (1) the association between body weight and the frequency of migraine attacks, (2) the possible differences in anxiety and depression symptoms according to the frequency of attacks and body weight, and (3) the possible mediating role of anxiety and/or depression in the association between body weight and frequency of migraine attacks in children. Methods: One hundred and eleven children/adolescents with migraine were included (47 boys and 64 girls; mean age 11.7; ±2.4 years). The patients were classified as: (1) high frequency patients, reporting from weekly to daily episodes and (2) low frequency patients, with ≤3 episodes per month. According to their body mass index percentiles, the patients were divided in "Normal weight" (from ≥5 to <85 percentile), "Overweight" (from ≥85 to <95 percentile), and "Obese" (≥95 percentile). Given the low number of obese patients, the overweight and obese groups were considered together in the "Overweight" group. Anxiety and depression symptoms were assessed by the Self-Administered Psychiatric Scales for Children and Adolescents (SAFA). Results: Fifty-four patients were normal in weight (49.6%), while 56 patients (50.4%) were overweight. The overweight patients showed a higher frequency of migraine attacks (64.7%; p < 0.05). Patients with a high frequency of attacks reported higher scores in all SAFA-Anxiety subscales (SAFA-A Tot: F = 15.107; p = 0.000). Overweight patients showed a significantly higher score in the "Separation anxiety" subscale (F = 7.855; p = 0.006). We found a mediating role between the overweight and high frequency for total anxiety (z = 2.11 ± 0.03; p < 0.05) and social anxiety (z = 2.04 ± 0.03; p < 0.05). Conclusions: Our results suggest that, among the children suffering from migraine, the overweight status is associated with a higher frequency of attacks and separation anxiety symptoms. In particular, our study provides the first evidence of the role of anxiety in linking overweight and the frequency of migraine attacks in children and adolescents.

Truths and Myths in Pediatric Migraine and Nutrition

“…Both conditions may be associated with anxiety and depression, which, in turn, may correlate with disability [91][92][93]. Our recent data showed that, at pediatric age, anxiety symptoms might be a vulnerability factor influencing not only the frequency of migraine attacks, but also the relationship between weight and migraine severity [79].…”

“…In recent years, an increasing body of literature has explored the association between migraine and obesity/overweight and the possible mechanisms behind their comorbidity, both in adulthood [72][73][74][75][76][77] and at pediatric age [6,7,67,78,79]. While many studies supported an association between overweight/obesity and headaches in children [6,7,68,78,79], some authors did not confirm this association [80][81][82][83]. The first pediatric study to demonstrate an association between obesity and primary headache was conducted in Israel by Pinhas-Hamiel et al (2008).…”

“…More recently, we showed a high prevalence of overweight/obesity (50.4%) among children/adolescents with migraine. Moreover, 64.7% of patients with a high frequency of headache attacks were overweight, while 35.3% were normal-weight [79].…”

“…The psychological aspects of the relationship between migraine and overweight also need to be considered [78,79]. Both conditions may be associated with anxiety and depression, which, in turn, may correlate with disability [91][92][93].…”

“…Given the potential impact that body weight can have on migraine outcomes, special attention should be paid to children's and adolescents' body weight and lifestyle. Emerging areas of therapeutic potential include dietary and lifestyle modifications, increased physical activity, and psychotherapy [67,73,79]. Interventions addressed to modify BMI may be relevant to reduce migraine severity.…”