Pain Catastrophizing Not Associated With Chronic Migraine in Children

While migraine is the most common cause of primary headache in children and leads to a decrease in the quality of life, pain catastrophizing does not seem to be associated with chronic migraine, according to a recent study.

Chronic migraine is a common reason for pediatric patients to seek medical care; it affects 0.8% to 1.8% of adolescents and 0.6% of children. The researchers said understanding specific pain mechanisms, disease progression, and potential complications in childhood migraine could allow for the creation of more targeted prevention and treatment for this population.

In the study of pain, pain catastrophizing—described as is a negative cognitive-affective response to anticipated or actual pain—has become a focus of study over the past decade. It is a complex process involving cognitions, emotions, and behavior, and is linked to poorer outcomes.

Researchers wrote that pain catastrophizing could be a model to explain how pain becomes chronic during childhood and adolescence; in addition, it may be a way to differentiate cases that could fare poorly, where pediatric patients would show multiple psychological and cognitive features.

The study had 3 aims:

• To evaluate pain catastrophizing in children and adolescents with episodic and chronic migraine in a tertiary headache center.
• To test whether the children's pain catastrophizing might be associated (a) with the frequency of attacks and disability, (b) with psychopathological aspects, and/or (c) with allodynia and total tenderness score as symptom of central sensitization.
• To test the best discriminating clinical variables and scores between episodic and chronic migraine, including pain catastrophizing.

Researchers conducted a cross-sectional observational study on consecutive pediatric patients affected by migraine. We selected 190 headache patients who met the diagnostic criteria for migraine without aura, migraine with aura, and chronic migraine.

All children were asked questions found on the child version of the Pain Catastrophizing Scale (PCS-C); the disability scale for migraine (PedMIDAS); the general quality of life estimated by children (PedsQL) and parents (PedsQL-P); and anxiety and depression (SAFA-A; SAFA-D) scales.

The authors also evaluated headache frequency and the presence and severity of allodynia and pericranial tenderness. Children were examined when they were not symptomatic.

PCS-C items describe different thoughts and feelings that children may experience when they are in pain, using a total score and three subscale scores for rumination, magnification, and helplessness. But researchers found no difference in the PCS-C between the chronic and episodic migraine groups (ANOVA F = .59, P = .70).

The PCS-C was not correlated with migraine-related disability, as expressed by Ped MIDAS, but it was significantly correlated with general low quality of life, allodynia, pericranial tenderness, anxiety, and depression.

The PedMIDAS, the PedsQL-P for physical functioning, and the Total Tenderness Score were discriminant variables between episodic and chronic migraine.

The researchers said pain catastrophizing seems to be a mental characteristic of a clinical phenotype with psychopathological traits, and increased sensitization symptoms. As a result, a child with this profile experiences a lower quality of life, one that is not fully understood by parents. While it is not a feature of chronic migraine, the researchers said it could be worth further prospective evaluation, because it could predict a worse progression.

Reference

Sciruicchio V, Simeone M, Grazia Foschino Barbaro M, et al. Pain catastrophizing in childhood migraine: an observational study in a tertiary headache center [published online February 15, 2019]. Front. Neurol. doi: 10.3389/fneur.2019.00114.