Negative effects of accompanying psychiatric disturbances on functionality among adolescents with chronic migraine

Abstract

Background Chronic migraine is a condition with gradually increasing prevalence among adolescents which causes severe headaches resulting in functionality loss. Factors contributing to migraine becoming chronic and negatively affecting quality of life in adolescence are still unclear. Parallel with these, we aimed to examine the effect of psychiatric symptoms on headache severity and functionality loss among adolescents with chronic migraine. Methods We evaluated features of 50 adolescents who were diagnosed with chronic migraine according to International Classification of Headache Disorders-3 for the first time in their lives by an experienced neurologist. Sociodemographic and clinical data were collected and Pediatric Migraine Disability Assessment Score, Visual Analogue Score and DSM-5 Level 1 Cross-Cutting Symptom Measure Scores (CCSM-5) were evaluated. Semi-structured psychiatric interviews were done to those who scored higher than cut-off scores on CCSM-5. Healthy control group was constituted of cases which had similar age and sex distribution to case group. Results Majority of the case group was female (%78). There was a positive correlation between headache severity and computerized tomography history in emergency department. All of the psychiatric symptom scores were significantly higher in case group except for psychotic symptoms; but attention problems and manic symptoms clusters did not have significant difference according to the thresholds of CCSM-5. Receiving a psychiatric diagnosis did not affect frequency, severity or duration of headaches. There were also no relationship between depression/anxiety diagnosis and severity of headache/functionality loss. Conclusion Findings suggest that; more rational treatment methods with lesser functionality loss should be developed by adopting multidisciplinary and prospective approach via psychiatric screening for adolescents with chronic migraine.

Anxiety and depressive symptoms and migraine‐related outcomes in children and adolescents

“…33 Finally, another published cross-sectional study did not show any associations among internalizing symptom scores, disability, and headache severity. 19 Thus, cross-sectional studies have not consistently found that higher internalizing symptom burden or comorbid internalizing disorders are associated with worse migraine-related outcomes in children and adolescents. Also, by virtue of their lack of follow-up, cross-sectional studies cannot assess the temporality of these associations nor discuss causality.…”

“…This low/ moderate effect size was selected as it is conservative compared to previously reported effect sizes in similar studies. [18][19][20][21] In understanding what an effect size of 0.35 would mean clinically for each outcome examined, using the standard deviation in PedMIDAS and headache frequency scores reported in the CHAMP trial, 22 an effect size of 0.35 would equate to: (a) a PedMIDAS change score of 9.4 between visits, and (b) a headache frequency change of 2.1 days/ month between visits. The sample size was therefore deemed large enough to be clinically relevant as well as small enough to minimize the probability of a false negative conclusion.…”

“…To detect a low/moderate association (effect size = 0.35) between the mental health variables and migraine outcomes, assuming β = 80%, α = 0.05, and the inclusion of six variables (i.e., age, sex, baseline headache frequency, preventive treatment type, baseline anxiety symptoms, and baseline depression symptoms) in a multivariable linear regression model, we required a sample size of N = 118 participants. This low/moderate effect size was selected as it is conservative compared to previously reported effect sizes in similar studies 18–21 . In understanding what an effect size of 0.35 would mean clinically for each outcome examined, using the standard deviation in PedMIDAS and headache frequency scores reported in the CHAMP trial, 22 an effect size of 0.35 would equate to: (a) a PedMIDAS change score of 9.4 between visits, and (b) a headache frequency change of 2.1 days/month between visits.…”

An epidemiological study of migraine headaches among the staff of Shahid Beheshti Hospital in Kashan, Iran, and related factors

“…(10) Research and clinical evidence show that early life stress contributes to long-term changes in the sympathetic nervous system, which are the main pathways for anxiety. (11) Multiple studies have examined the relationship between migraine headaches and physical fatigue, emotional stress, depression, and other factors in the general population and specific subgroups, including students (12). According to the study Yamanaka et al (13) showed that behavioral and lifestyle interventions are not proven to reduce headaches.…”

“…Research and clinical evidence show that early life stress contributes to long-term changes in the sympathetic nervous system, which are the main pathways for anxiety. (11)…”