Depressive Illness in Childhood Presenting as Severe Headache

Abstract

A group of 25 children presenting with headache to a child neurology service were retrospectively evaluated for the presence of depression by using a set of arbitrarily chosen criteria based on observable behavioral factors. A significant number (ten of 25) were shown to have a depressive illness recognizable by the criteria used. It seems reasonable to assume that childhood depression as a clinical entity does occur and could be recognized by a systematized clinical approach with emphasis on the behavioral changes of the patients. The criteria used in the present study appear to be useful for this purpose. It is suggested that prospective studies using these or similar criteria are warranted.Headache is frequently encoun-, tered in adults suffering from manic depressive disease. Indeed, it is probably the major somatic com¬ plaint which brings such patients to the neurologist. Relief from head¬ ache accompanies effective treatment of the depression, whereas treatment of the headache symptomatically with analgesics is rarely effective. The present study was designed to assess the frequency of depression in a cohort of children referred to a child neurology service with head¬ ache as the principal complaint. Materials and MethodsApproximately 800 patients were eval¬ uated at the St. Louis Children's Hospital Private Neurology Service in the past two years. Only patients with the presenting complaint of headache were selected, al¬ though some had other complaints such as sleep disturbances, behavior problems, and learning disabilities. Patients who were suffering from epilepsy, other organ¬ ic diseases, or manifesting serious residua as a result of prior neurological disease were excluded.Twenty-six patients qualified for the study. One patient, an adopted child, was subsequently excluded because of in¬ adequate information on the natural par¬ ents. The study involved, therefore, 25 patients. All were white children between the ages of 4 and 16 years, with 21 of them 12 years or younger. There were 13 boys and 12 girls.Their records were reviewed and the clinical features analyzed and tabulated according the criteria below. Where the information was not adequately recorded, the families were reinterviewed. Diagnostic CriteriaDepression.-There are no general¬ ly accepted diagnostic criteria for childhood depression. However, the clinical characteristics of adult de¬ pression have been well established. We, therefore, elected to base diag¬ nostic criteria along the lines estab¬ lished by Cassidy and his colleagues,1 but rely on those factors more read¬ ily observable in children. The fol¬ lowing criteria were arbitrarily se¬ lected: 1. Significant mood change 2. Social withdrawal 3. Increasingly poor performance in school 4. Sleep disturbances 5. Aggressive behavior not previ¬ ously present 6. Self-deprecation and beliefs of persecution 7. Lack of energy 8. Somatic complaints other than headache 9. School phobia 10. Weight loss and anorexiaEmphasis was placed on recent changes in behavior. We considered mood changes ...

Depression in Childhood

“…The concept of masked depression has been well supported in the literature by others. In the same way other authors have described a number of different behavioural manifestations as being due to depression, including anger and acting out behaviour (Chwast, 1967;Spiegel, 1967), school phobia (Agras, 1959), poor school performance (Hollon, 1970), severe headache (Ling et al, 1970), psychosomatic problems (Lesse, 1968), hyperactivity (Malmquist, 1971;Zrull et al, 1970), and stealing (Krakowski, 1970). Some of these so-called masks which have been described are thought to be aggressive behaviour as a means of concealing depression (Burks and Harrison, 1962).…”

Effective Prophylactic Therapy for Cyclic Vomiting Syndrome in Children Using Amitriptyline or Cyproheptadine

“…In fact a wide variety of medications have been reported to be of benefit for antimigraine and CVS prophylaxis, including amitriptyline, cyproheptadine, propranolol, carbamazepine, and calcium channel blockers. 2,10,12,15,[23][24][25] Erythromycin is reportedly effective for the prevention of CVS. 11 Although the modes of action for all these drugs are unknown but based on the diverse nature of the reportedly effective prophylactic agents, one can hypothesize there must be multiple steps in the pathogenesis of both migraine and CVS that may be blocked to prevent clinical expression of the syndromes.…”

Conversation with W alter L ing

“…I had just finished a study on childhood depression, something the majority of the field thought not to exist, as depression was supposed to be the super ego punishing the ego, and children had no developed super ego. But of course children do get depressed, so Warren Weinberg (a leading child neurologist) and I conducted a study on childhood depression [1]. We set up the first diagnostic criteria, patterned after DSM-III, except that this was a decade before DSM-III actually appeared.…”