Personality and Behavioural Characteristics in Pediatric Migraine

Abstract

SYNOPSISPersonality and behavioural features in pediatric migraine were investigated in a comparison study of 20 boys and girls with migraine, matched for age and sex with a "pain" control group of 20 children with musculoskeletal pain, and with a "no-pain" control group of 20 children. When the amount of pain experienced by children was controlled, the only discriminating variable was that of somatic complaints which included vomiting, nausea, and perceptual disturbances, all migraine-related phenomena. The inclusion of the "pain" control group in this investigation yielded results which indicated that the behavioural and personality features thought to be characteristic of childhood migraine are common to a chronic pain disorder and in fact, the manifestation of many of these features correlate directly with the amount of pain experienced. It is suggested that the personality and behavioural characteristics evident in many children with migraine may result from the recurrent chronic pain episodes rather than in some way being causative of the pain. (Headache 27:16-20, 1987) Migraine headaches in children are a common phenomenon 1 and a number of investigators have described personality and behavioural characteristics which they believe contribute to the occurrence of the headaches. This view was first espoused by Harold Wolff (described by Anderson) 2 in his description of the childhood personalities of his adult migraine patients, as reported retrospectively by the patients and their families. More than half of the migraineurs were described as delicate, shy, withdrawn, sober, polite, well-mannered, conscientious, responsible, unusually thoughtful, and extremely obedient to parental wishes. These sterling, if somewhat submissive qualities were said to co-exist with unusual obstinacy, stubborness and inflexibilty. As children, these individuals were remembered as being very neat and clean and as adolescents, more than usually concerned with moral and ethical issues.Wolff's observations, although of heuristic value, are fraught with major methodological problems. This population included only people who continued to have headaches in adulthood and who sought help from a specialist. The reliance on retrospective family and self-descriptions may well have been biased. The use of an unstructured clinical interview to gather information may have elicited recollections that were in keeping with the interviewer's own opinions. Finally, the lack of any control group prevented meaningful comparisons with individuals who did not have headaches.Wolff's observations, with some variations, have been supported by numerous subsequent investigations with children with migraine, rather than with adult migraineurs recalling their childhood. 3-9 However, most have been marred by major methodological flaws that have compromised their validity.For example, Koch and Melchoir 4 found that 39 of their 136 pediatric migraine patients exhibited some degree of mental symptoms related to stress. Similarly, Krupp and Friedman 5 noted s...

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