Abstract
The literature examining primary headache, including migraine, in adolescents, has pointed out the key role played by a wide range of psychiatric disorders in reducing the patients’ quality of life. Moreover, pioneering studies showed that preexisting personality characteristics, specific emotion regulation styles and psychological-psychiatric difficulties are likely to increase the risk of the onset, maintenance, and outcome of headache. Still personality issues in migraine have been poorly studied, in particular in children and adolescents. This study aims, therefore, to investigate the specific characteristics of personality, and in particular emotion regulation and coping strategies, in adolescent with migraine, comparing them with age-matched patients with idiopathic epilepsy and healthy adolescents. 52 adolescents (age: 11–17) were assessed using a multi-method test battery, which included a self-report questionnaire (the youth self-report), a proxy-report (child behavior checklist) along with a projective personality test, the Rorschach Test, administered and scored according to the Exner comprehensive system. The results showed specific personality characteristics in adolescents with migraine, revealing a marked difficulty in modulating and regulating affections through thoughts and reflections, resorting instead to impulsive acts and maladaptive coping strategies, thus revealing a vague and immature perception of reality. Differently from adolescents belonging to the general population, but similarly to patients with epilepsy, adolescents with migraine perceive a high situational stress, probably related to the condition of suffering from chronic disease. They have, therefore, a lower self-consideration and self-esteem along with a poorer insight regarding themselves as well as the relations with others. In line with previous findings, these preliminary results suggest the need for further research on ample samples, using also standardized projective test in order to better understand the pathogenesis of psychological difficulties in patients with migraine. As a clinical implication, the results seem to indicate that providing a psychological integrated approach can play a pivotal role in the assessment and treatment of adolescent with migraine, in order to improve the outcome and the quality of life of the young patients.
Highlights
Concerning the proxy-reported child behavior checklist (CBCL) scale, administered to mothers, higher scores for internalizing symptoms and in particular anxiety symptoms and somatic complaints were found in patients with migraine compared to patients with epilepsy group and controls
In the parent reported questionnaires, the migraine group obtained higher scores in internalizing problems and in particular in anxious and somatic symptoms. These findings are in line with the literature data indicating higher levels of internalizing, anxious, and somatic problems in children and adolescents with migraine compared to healthy controls [17, 23]
There are, no statistically significant differences between the epilepsy group and the healthy control group, differently from Pinquart and Shen’s meta-analysis [53], where high levels of internalizing problems were found in all types of chronic illnesses analyzed, including headache and epilepsy [54, 55]
Summary
Personality and emotional characteristics in adolescents with migraine began to be more in-depth studied in recent years: literature showed an increased interest in emotional aspects, such as anxiety and depression, and in their value for the clinical approach, therapy, and comprehension of the adolescent migraine’s key characteristics [1,2,3,4,5].The majority of the authors currently consider migraine as a complex neurological disorder of higher mental functions and pain control mechanism, not linked to structural lesions: in particular strong pathogenic mechanisms have been recognized in genetic predisposition, cortical hyperexcitability, habituation deficits, and cognitive dysfunctions, instability of the autonomic nervous system and of the neurons’ energy supply or in other cases medication overuse [6, 7]. The genetic bases, biological mechanisms, cerebral blood flow variations during attacks, electrical alterations occurring in parallel and biochemical modifications seem to have been deeply studied, leading to certain conclusions, which seem almost inviolable; on the other hand, the definition and comprehension of the environmental factors’ value, and in particular of the psychological and psychiatric ones, seems to be still far more complex and uncertain [9]. Relevant meta-analyses [10,11,12,13] and recent high impact researches [14] showed a lack of efficacy of the candidate drugs for the prevention of migraine attacks in adolescence and, on the other hand, a good effectiveness of the “psychological” techniques. Placebo was showed to have a surprisingly high therapeutic value: a 50% reduction (at least) of the days with headache was achieved in about 60% of patients [14] and in 58% of the placebo produced a positive response when used as a pain-reliever for migraine attacks [15]
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