Evaluating Psychiatric Disorders Among Adolescents With Chronic Migraine

More treatment methods focused on reducing functionality loss and adopting multidisciplinary and prospective approaches via psychiatric screening should be developed for adolescents with chronic migraine (CM), researchers writing in BMC Neurology concluded.

Approximately 3.5% of adolescents suffer from headaches, while around 69.0% of adolescents referred to headache centers are diagnosed with CM, authors explained.

As biological, cognitive, emotional, and behavioral factors are known to contribute to headache occurrences during adolescence, evaluating comorbid psychiatric conditions among this cohort may provide insights into more comprehensive and effective treatments.

To compare psychiatric diagnoses/symptoms of adolescents with CM with healthy controls, investigators evaluated individuals’ features using the Pediatric Migraine Disability Assessment Score (PedMIDAS), Visual Analogue Scale (VAS), and Diagnostic and Statistical Manual-5 Level 1 Cross-Cutting Symptom Measure Scores (CCSM-5). The study was carried out at a hospital in Turkey.

All patients (N = 50) in the cross-sectional case-control study were between the ages 12 and 18, had no previous neurological disease history, and were diagnosed with CM by a neurologist. Demographic, physical, and neurological characteristics were also assessed. Each patient was matched by gender, age, and socioeconomic level to a healthy control.

The majority (78%) of patients were female with a mean (SD) age of 15.5 (1.5) years. Data also showed “time between emergence of headache symptoms and clinical referral was 18.8 (21.3) months and [patients] had mean headache duration of 20.7 (6.78) days per month.”

Analyses revealed:

• A positive correlation between headache severity and computerized tomography history in the emergency department
• All of the psychiatric symptom scores in CCSM-5 were significantly higher in the case group except for psychotic symptoms
• Attention problems and manic symptoms clusters did not have significant differences according to the thresholds of CCSM-5
• Positive correlations between attention problem scores on CCSM-5 and VAS (P = .005) and PedMIDAS (P = .013) scores
• A positive correlation between somatic symptom scores on CCSM-5 and PedMIDAS (P = .004) scores
• Receiving a psychiatric diagnosis did not affect frequency, severity or duration of headaches
• No relationship between depression/anxiety diagnosis and severity of headache/functionality loss

The most common comorbid psychiatric disorders among patients with CM were major depressive disorder (MDD) and generalized anxiety disorder. Patients also exhibited bipolar disorder (2%), obsessive-compulsive disorder (OCD) (2%), OCD and MDD comorbidity (2%), and attention-deficit/hyperactivity disorder (6%).

Overall, “somatic, anxious, aggressive, attention deficit, irritable and depressive symptoms in CCSM-5 were significantly higher in adolescents with CM compared to healthy controls,” authors wrote. However, positive correlations between VAS and somatic symptom scores could be due to the negative impacts of pain on sensorial and cognitive factors.

The cross-sectional design and small sample size of the study preclude any cause-and-effect conclusions from being drawn, marking a limitation. Results may also not be generalizable to the wider population. “Further studies with larger sample sizes are needed in order to portray a more defined framework about the relationship between CM and psychological well-being,” authors wrote.

Reference

Cankay TU and Besenek M. Negative effects of accompanying psychiatric disturbances on functionality among adolescents with chronic migraine. BMC Neurol. Published online March 3, 2021. doi:10.1186/s12883-021-02119-6