Migren Tipi Baş Ağrısı Olan Çocuklarda Anksiyete Düzeyi Artmakta mıdır?

Amaç: Migren çocuklarda sık görülen primer baş ağrısı nedenlerindendir. Migren hastalarında psikiyatrikkomorbidite de bildirilmektedir. Bu çalışmada migren tanısı alan çocukların ve migrensiz gönüllülerin anksiyete düzeyleri arasında anlamlı bir fark olup olmadığını araştırmak amaçlanmıştır.Gereç ve Yöntemler: Çocuk nöroloji polikliniğimizde prospektif, vaka kontrollü, kesitsel bir çalışma gerçekleştirildi. Çalışmaya baş ağrısı şikayetiyle başvurup migren tanısı alan çocuklar (çalışma grubu) ilebaşka nedenlerle başvurup herhangi bir kronik hastalık saptanmayan gönüllü çocuklar (kontrol grubu)dahil edildi. İki gruba da Çocuklarda Anksiyete Bozukluklarını Tarama Ölçeği (ÇATÖ) uygulandı ve aldıkları puanlar karşılaştırıldı. Ayrıca migrenli hastaların ÇATÖ puanı ile migren atak sıklığı ve hastalık süresiarasındaki ilişki incelendi.Bulgular: Çalışma grubunda 83 çocuk (29 erkek, 54 kız) vardı ve yaş ortalaması 13,23±2,3 yıldı. Kontrolgrubunda 80 çocuk (36 erkek, 44 kız) vardı ve yaş ortalaması 13,97±2,6 yıl idi. İki grup arasında yaş vecinsiyet açısından istatistiksel olarak anlamlı fark saptanmadı. Çalışma ve kontrol grubu ortalama ÇATÖpuanları sırasıyla 26,4±11,9 ve 26,6±12,4 olarak tespit edildi ve istatistiksel olarak anlamlı fark bulunmadı(p=0,93). Çalışma grubundan 46 (%55,4), kontrol grubundan 41 (%51,2) çocuğun ÇATÖ puanı ≥25 (patolojik eşik değer) idi; kaygı bozukluğu riski iki grup için de yüksekti. Çalışma grubunda hastalığın süresiile ÇATÖ puanı arasında korelasyon saptanmadı (r=0,15, p=0,17), fakat atak sıklığı ile ÇATÖ puanı arasındapozitif korelasyon saptandı (r=0,35, p=0,001).Tartışma ve Sonuç: Migrenli ve migrensiz çocukların anksiyete düzeyleri arasında anlamlı bir fark saptamamış olsak da, atak sıklığı arttıkça anksiyete düzeyi yükselebileceği için migrenli hastaların anksiyeteaçısından yakından takibinin yararlı olacağı kanaatindeyiz.

Do Children with Migraine-type Headache Exhibit Increased Levels of Anxiety?

Aim: Migraine is a common cause of primary headache in children. Psychiatric comorbidity has also been reported in migraine patients. In this study, we aimed to investigate whether there was a significant difference between the anxiety levels of children diagnosed with migraine and volunteer children without migraine. Materials and Methods: We carried out a prospective, case-controlled, cross-sectional study in our pediatric neurology outpatient clinic. The study included children who presented with headache and were diagnosed with migraine (the study group) and volunteer children who presented with other complaints and were found to have no chronic disease (the control group). Both groups were assessed with the Screen for Child Anxiety Related Emotional Disorders (SCARED) and their scores were compared. We also investigated the relationship between the SCARED scores and migraine attack frequency and illness time. Results: The study group consisted of 83 children (29 boys, 54 girls) with a mean age of 13.23±2.3 years and the control group 80 children (36 boys, 44 girls) with a mean age of 13.97±2.6 years. No statistically significant difference was found between the two groups in terms of age and sex. The mean SCARED scores of the study and control groups were 26.4±11.9 and 26.6±12.4, respectively; and there was no significant difference (p=0.93). Forty-six children (55.4%) from the study group and 41 (51.2%) from the control group had a SCARED score ≥25 (the pathological cut-off value); the risk of an anxiety disorder was high for both groups. For the study group, we found that the SCARED score was not correlated with illness time (r=0.15, p=0.17), but had a positive correlation with attack frequency (r=0.35, p=0.001). Discussion and Conclusion: Although we found no significant difference between the anxiety levels of the children with and without migraine, we think that close follow-up for anxiety would be beneficial in migraine patients because the patient’s level of anxiety could increase with migraine attack frequency.

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1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.
2. Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol. 2010;52(12):1088–97.
3. Ozge A, Bugdayci R, Sasmaz T, Kaleagasi H, Kurt O, Karakelle A, ve ark. The sensitivity and specificity of the case definition criteria in diagnosis of headache: a school-based epidemiological study of 5562 children in Mersin. Cephalalgia. 2002;22(10):791–8.
4. Machnes-Maayan D, Elazar M, Apter A, Zeharia A, Krispin O, Eidlitz-Markus T. Screening for psychiatric comorbidity in children with recurrent headache or rent abdominal pain. Pediatr Neurol. 2014;50(1):49–56.
5. Wang SJ, Juang KD. Psychiatric comorbidity of chronic daily headache: impact, treatment, outcome, and future studies. Curr Pain Headache Rep. 2002;6(6):505–10.
6. O’Brien HL, Slater SK. Comorbid psychological conditions in pediatric headache. Semin Pediatr Neurol. 2016;23(1):68–70.
7. Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, ve ark. The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry. 1997;36(4):545–53.
8. Çakmakçı FK. Çocuklarda Anksiyete Bozukluklarını Tarama Ölçeği Geçerlik ve Güvenirlik Çalışması [yayımlanmamış uzmanlık tezi]. Kocaeli: Kocaeli Üniversitesi Tıp Fakültesi; 2004.
9. Bruijn J, Locher H, Passchier J, Dijkstra N, Arts WF. Psychopathology in children and adolescents with migraine in clinical studies: a systematic review. Pediatrics. 2010;126(2):323–32.
10. Güler G, Meryem Ozlem K, Fevziye T, Aynur Ö, Bahar T. The high level of psychiatric disorders associated with migraine or tension-type headache in adolescents. J Neurol Sci (Turkish). 2017;34 (4):312–21.
11. Kandemir G, Hesapcioglu ST, Kurt ANC. What are the psychosocial factors associated with migraine in the child? Comorbid psychiatric disorders, family functioning, parenting style, or mom’s psychiatric symptoms? J Child Neurol. 2018;33(2):174–81.
12. Oztop DB, Tasdelen BI, Poyrazoglu HG, Ozsoy S, Yilmaz R, Sahin N, ve ark. Assessment of psychopathology and quality of life in children and adolescents with migraine. J Child Neurol. 2016;31(7):837–42.
13. Heckman BD, Holroyd KA, Himawan L, O’Donnell FJ, Tietjen G, Utley C, ve ark. Do psychiatric comorbidities influence headache treatment outcomes? Results of a naturalistic longitudinal treatment study. Pain. 2009;146(1–2):56–64.
14. Slater SK, Kashikar-Zuck SM, Allen JR, LeCates SL, Kabbouche MA, O’Brien HL, ve ark. Psychiatric comorbidity in pediatric chronic daily headache. Cephalalgia. 2012;32(15):1116–22.
15. Guidetti V, Galli F. Recent development in paediatric headache. Curr Opin Neurol. 2001;14(3):335–40.
16. Just U, Oelkers R, Bender S, Parzer P, Ebinger F, Weisbrod M, ve ark. Emotional and behavioural problems in children and adolescents with primary headache. Cephalalgia. 2003;23(3):206–13.
17. Fielding J, Young S, Martin PR, Waters AM. Headache symptoms consistent with migraine and tension-type headaches in children with anxiety disorders. J Anxiety Disord. 2016;40:67–74.
18. Jette N, Patten S, Williams J, Becker W, Wiebe S. Comorbidity of migraine and psychiatric disorders--a national population-based study. Headache. 2008;48(4):501–16.
19. Anttila P, Sourander A, Metsahonkala L, Aromaa M, Helenius H, Sillanpaa M. Psychiatric symptoms in children with primary headache. J Am Acad Child Adolesc Psychiatry. 2004;43(4):412–9.