Obesity Associated With More Attacks, Separation Anxiety in Pediatric Migraineurs

Among children and adolescents suffering from migraine, results from a prospective study show being overweight is associated with a higher frequency of migraine attacks and separation anxiety symptoms. The findings were published in Frontiers in Psychology.

Migraine and obesity are common conditions among pediatric populations as epidemiological studies have found prevalence of migraine ranges from 3% in preschool age children to 8% to 23% in adolescents. Obesity and migraine are multifactorial diseases influenced by genetic, environmental, and psychological factors, and are associated with a poor quality of life, high health care costs, and increased risk of psychological disorders, researchers wrote.

Previous evidence has shown a beneficial effect of weight loss on headache severity while additional studies have documented the association of being overweight and the transformation of episodic migraine to chronic migraine. However, literature on the associations is inconclusive.

“Little is known about the psychological profile of headache patients who suffer from being overweight,” authors explained. “Data concerning the possible association between body weight, psychological factors, and headache are sparse, and involves only adult patients.”

In the current study, researchers set out to explore the role of weight and psychological symptoms on pediatric migraine by investigating the association between the 2 conditions, possible differences in anxiety and depression symptoms, and the potential mediating role of anxiety and depression in the association between bodyweight and frequency of migraine attacks. It is the first to investigate the association between body weight and anxiety depression in children migraineurs.

A total of 111 patients who presented to a headache center in Rome between January 2015 and April 2017 were included in the study. Mean (SD) patient age was 11.7 (2.4) years while the majority of patients (n = 64) were female. At the first clinic visit, all participants underwent a neurological examination and general physical exam. All patients were diagnosed with migraine without aura based on criteria of the International Classification of Headache Disorders, 3rd edition.

Participants also completed a headache diary between the 1st and 2nd visits to the clinic, documenting attack frequency. Patients were divided into 2 groups: high frequency (HF) patients with weekly to daily attacks, and low frequency (LF) patients with 3 or less episodes documented per month.

Researchers used the Italian Self-Administered Psychiatric Scales for Children and Adolescents (SAFA) battery of tests to assess psychiatric symptoms and psychological conditions. These include anxiety-related areas (SAFA-A), depression-related areas (SAFA-D), somatic concerns (SAFA-S), obsessive-compulsive symptoms (SAFA-O), psychogenic eating disorders (SAFA-P), and phobias (SAFA-F).

Of the 111 participants, 55 (49.6%) were normal weight (NW) and 56 (50.4%) were classified as overweight (OW; overweight/obese) based on body mass index (BMI) measurements. Mean BMI among this cohort was 29.5 (5.2). In addition, 60 children (54%) reported LF of attacks and 51 (45.9) reported HF.

Analyses revealed:

• HF patients were more common in the OW group (64.7%) than among the NW patients (35.3%; OR 2.5; CI 1.1–6.3; P < .05)
• 61.7% of the LF patients had normal body weight, while 38.3% were overweight
• No gender or age differences were found between the HF and LF patients nor between the NW and OW patients
• HF children showed higher levels of total anxiety as compared with the LF patients (SAFA-A Total: F = 15.107; P < .0001)
• HF patients reported higher scores in all the SAFA-A subscales (P < .025), suggesting that the HF patients were more anxious in several fields, such as school (P < .025), social relationships (P < .025), and separation from parents (P < .025)
• OW patients showed significantly higher scores in the “Separation anxiety” subscale (F = 7.855; P < .01)
• Sobel’s test showed a mediating role between being overweight and HF of attacks for social anxiety (z = 2.04 [0.03]; P < .05) and total anxiety (z = 2.11 [0.03]; P< .05)

Overall, results confirm the possible interaction between weight and migraine severity and may have clinical implications for the management and treatment of pediatric migraine.

As most drugs used for migraine prophylaxis can lead to body weight increase and because BMI increase can worsen migraine, researchers argue this factor should be taken into account when prescribing these medications to children and adolescents, especially when the treatment is associated with a paradoxical increase in attack frequency.

“In our study, the association between migraine, overweight, and separation anxiety symptoms may be due to the common psychological vulnerability factors,” researchers wrote. “Migraine and obesity may share an increased risk for internalizing disorders, difficulties in emotional regulation, and dysfunctional mother-child interaction.”

Obese children often exhibit low self-esteem, social anxiety, and social isolation, characteristics which have also been described in children with migraine. Authors hypothesize social anxiety may be amplified by being overweight, causing children to be less able to meet social expectations and potentially promoting migraine onset or aggravate attacks.

To prevent the cycle between weight, anxiety, and migraine, researchers suggest detecting anxiety symptoms, in particular social anxiety, could mitigate the effect of weight on migraine severity and may reduce the risk of migraine chronification. “A psychological intervention, such as cognitive-behavioral, may help children with migraine to identify and modify their negative thoughts about self, and may improve children’s self-esteem and coping ability.”

As the study only included children referred to a single center, results may not be representative of the entire pediatric migraine population, marking a limitation to the study. Psychological tools were based on self-reported questionnaires and are not diagnostic for anxiety or depression. Future studies ought to also differentiate between overweight and obsess patents.

“Because of the potential impact that the psychological symptoms and body weight can have on the migraine outcome, a systematic evaluation of children and adolescents with migraine should include both a psychological screening and a particular concern about body weight,” researchers concluded.

Reference

Tarantino S, Papetti L, Di Stefano A, et al. Anxiety, depression, and body weight in children and adolescents with migraine. Front Psychol. Published online October 28, 2020. doi:10.3389/fpsyg.2020.530911