Behavioural and Temperamental Characteristics of Children and Adolescents Suffering from Primary Headache

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.

Present and previous psychopathology of juvenile onset migraine: a pilot investigation by Child Behavior Checklist

“…Mazzone et al assessed tension-type headache, migraine patients and controls using the CBCL (and other tests). Although most headache patients had scores within the normative non-pathological range, both tension-type headache and migraine patients had higher CBCL total, internalising and externalising scores than controls [28].…”

“…Egger et al studied a large population of children aged 9-15 years: girls who met DSM-III-R criteria for a depressive disorder had a four times higher prevalence of headaches than girls who were not depressed; girls with anxiety disorders had a three times higher prevalence of headaches than girls who were not anxious [39]. Mazzone et al found that a higher proportion of tension-type headache patients had pathological CBCL total and internalising scores than controls while children with migraine had a pathological score only for the internalising scale [28].…”

Associations between stress and migraine and tension-type headache: Results from a school-based study in adolescents from grammar schools in Germany

“…One hypothesis is that subjects who complain about TTH might have better coping strategies for stress, which might protect them from developing a central hyper-excitability. Another hypothesis is that subjects with TTH are more likely to develop muscular tenderness as a reaction to stress (27), but are less vulnerable to psychological stress, for example from anxiety or depression (28)(29)(30).…”

Medical causes of headache in children

“…Up to 80% of children with headache have comorbid psychiatric disorders, including anxiety and depression [30], and comorbidity is associated with increased disability [31], increased headache severity, and lower likelihood of headache freedom [32]. Conversely, children with psychiatric disorders have a higher incidence of primary headache disorders.…”