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Migraine and Primary Headache in Adolescence: Emotional, Affective and Cognitive Aspects

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Migraine and primary headache have a significant impact on children and adolescents leading to reduced quality of life, absenteeism from school, decreased school performance and impaired psychosocial functioning. Although a lot of research efforts have been devoted to better understand and characterize ...

Migraine and primary headache have a significant impact on children and adolescents leading to reduced quality of life, absenteeism from school, decreased school performance and impaired psychosocial functioning. Although a lot of research efforts have been devoted to better understand and characterize migraine and primary headache in this age range, many questions remain still unanswered.

In particular, while much is known about the biological basis of migraine in adulthood and childhood so far, the relationship between migraine and emotional states and affects appears more complex. Several controlled clinical and population-based studies, as well as recent meta-analysis have highlighted that children and adolescents suffering from migraine and tension-type headache show significantly more psychopathological symptoms than healthy controls. Nevertheless some authors underline that the majority of children with migraine or tension-type headache do not exhibit high or clinical levels of psychiatric symptoms or disorders, in particular when assessment is based on self-rated instruments.

However, in clinical practice, specific personality traits are also frequently seen in children referred for headache such as rigid and normative personality, the presence of reduced empathy and ability to get in contact with and psychologically handle feelings and emotions. Moreover very often intense familiar conflicts, a history of adverse life-events and excessive parental expectancies emerge. Future research should pay special attention not only to the child but also to the family environment and parental psychopathology trying to evaluate the existence of inter-generational links.

In line with these premises, Cahill (2005) in a large longitudinal study in a cohort of children born in Dunedin (New Zealand) concludes that “migraine should represent a subtype of headache of particular interest for psychiatrists” and underlines the significant association “between stress, personality traits, psychiatric disorders and migraine,” which may open potential fruitful areas to explore in future studies.

Furthermore, while in adults several drugs have been approved for headache treatment and prevention, only one drug is approved by the FDA for migraine prevention and 4 randomized-control trials have shown inconsistent results in childhood and pharmacotherapy alone does not seem to be very effective compared to placebo. Opposite to that, as Eccleston (2013) stated “there is good evidence that psychological treatments, in particular relaxation techniques and cognitive-behavioral therapies are efficacious in reducing chronic headache frequency and severity in children and adolescents.”

Moreover, even though headaches are clearly associated with a reduction in school performance in children and adolescents, data regarding the effects of migraine and primary headache on their neuropsychological functions are rather sparse and not consistent; the most significant (but not definitive) findings are a relative reduction of verbal academic intelligence and of short-term memory with the average IQ falling in the normal range. Of importance, no studies, to our knowledge, have evaluated the potential role of headache characteristics (e.g. the frequency of attacks).

Starting from the findings above, it seems to be crucial to better clarify the bidirectional relationship between migraines - primary headaches and emotional - affective aspects as well as internalizing and externalizing disorders, and to deeply explore the possible effects of headaches on neuropsychological functions. This may help not only to achieve a better comprehension of these phenomena in children and adolescents, but also to improve the diagnosis, management as well as treatment in this age range.


Keywords: tension, chronic headache, migraine, childhood, adolescence, psychopathology, emotions, affections, cognition


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