Abstract
Background: Migraine is the most common cause of primary headache in children leading to a decrease in the quality of life. During the last decade, pain catastrophizing construct became a major focus of interest in the study and treatment of pain.Aim of the study: To evaluate pain catastrophizing in episodic and chronic migraine children and adolescents selected 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 (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.Methods: We 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. We submitted all children to the Child version of the Pain Catastrophizing Scale (PCS-C), and to the disability scale for migraine (PedMIDAS), general quality of life estimated by children (PedsQL) and parents (PedsQL-P), anxiety and depression (SAFA-A; SAFA-D) scales. We also evaluated headache frequency and the presence and severity of allodynia and pericranial tenderness.Results: No difference was detected in Total Pain Catastrophizing score (PCS-C) between chronic and episodic migraine groups (ANOVA F = 0.59, p = 0.70); the PedMIDAS, the PedsQL-P for physical functioning and the Total Tenderness Score were discriminant variables between episodic and chronic migraine. 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.Conclusion: Pain catastrophizing seems a mental characteristic of a clinical phenotype with psychopathological traits and enhanced expression of central sensitization symptoms. This clinical profile causes general decline in quality of life in the child judgment, with a probable parents' underestimation. In childhood age, it would not be a feature of chronic migraine, but the possibility that it could predict this evolution is consistent and worthy of further prospective evaluation.
Highlights
Migraine is the most common cause of primary headache in children leading to a decrease in the quality of life [1].Chronic migraine affects 0.8–1.8% of adolescents and 0.6% of children and it is a common reason for pediatric patients to seek medical care [2]
Among the 500 consecutive pediatric patients come for the first time to the Applied Neurophysiology and Pain unit between January 2017 and January 2018, we selected 190 headache patients who met the diagnostic criteria for Migraine without aura, Migraine with aura and Chronic migraine, according to the actual International Classification of Headache Disorders (Headache Classification Committee) [15]
The general impression emerging from the present results is that Pain Catastrophizing seems an important aspect of children with headache, associated with psychopathological features, general reduction of quality of life and central sensitization symptoms
Summary
Chronic migraine affects 0.8–1.8% of adolescents and 0.6% of children and it is a common reason for pediatric patients to seek medical care [2]. Flink et al argued that it is a form of negative repetitive thinking, difficult to disengage from, with reduced capacity in problem solving and downregulation of negative affect It is a complex process involving cognitions, emotions, and behavior, linked to poor outcomes such as higher ratings of pain and disability [4]. Pain catastrophizing construct became a major focus of interest in the study and treatment of pain
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