Dallavalle Gianfranco, Pezzotti Elena, Provenzi Livio, Toni Federico, Carpani Adriana, Borgatti Renato
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
Front Neurol. 2020 Oct 8;11:579047. doi: 10.3389/fneur.2020.579047. eCollection 2020.
Pediatric migraine is among the most common primary or comorbid neurologic disorders in children. Psychological stressors are widely acknowledged as potential triggers involved in recurring episodes of pediatric migraine. As the COVID-19 emergency may have affected the levels of stress perceived by children and adolescents with migraine, the present study was aimed to understand the effect of COVID-19 emergency on symptoms intensity and frequency in pediatric patients. A cohort of 142 child and adolescent patients with a diagnosis of migraine was enrolled at the Child Neurology and Psychiatry Unit of the IRCCS Mondino Foundation in Pavia (Italy). Socio-demographic and clinical characteristics were obtained from medical records. An on-line survey was used to collect information on COVID-19 exposure, stress response to the lockdown period, anxious symptoms during COVID-19 emergency, as well as migraine symptoms intensity and frequency before and during the lockdown. The great majority were outpatients ( = 125, 88.0%), 52 (36.6%) had migraine with aura, whereas, 90 (63.4%) had migraine without aura. All the patients reporting worsening symptoms progression before COVID-19, had reduced intensity during the lockdown (χ = 31.05, < 0.0001). Symptoms frequency reduction was observed in 50% of patients presenting worsening symptoms before the lockdown, 45% of those who were stable, and 12% of those who were already improving. All patients who had resolved symptoms before COVID-19 were stable during the lockdown (χ = 38.66, < 0.0001). Anxious symptomatology was significantly associated with greater migraine symptoms frequency (χ = 19.69, < 0.001). Repeating the analysis separately for individuals with and without aura did not affect the findings and significant associations were confirmed for both the patients' subgroups. A significant reduction of migraine symptoms intensity and frequency was observed in pediatric patients during the COVID-19 lockdown phase in northern Italy. The improvement in both intensity and frequency of the migraine symptoms was especially significant in patients who were stable or worsening before the lockdown. The reduction of symptoms severity during a period of reduced environmental challenges and pressures further highlights the need of providing effective training in stress regulation and coping for these patients.
小儿偏头痛是儿童中最常见的原发性或共病性神经系统疾病之一。心理压力源被广泛认为是小儿偏头痛反复发作的潜在触发因素。由于新冠疫情可能影响了偏头痛儿童和青少年所感受到的压力水平，本研究旨在了解新冠疫情对小儿患者症状强度和频率的影响。在意大利帕维亚的IRCCS蒙迪诺基金会儿童神经科和精神科招募了142名诊断为偏头痛的儿童和青少年患者。从医疗记录中获取社会人口统计学和临床特征。通过在线调查收集有关新冠病毒暴露情况、对封锁期的应激反应、新冠疫情期间的焦虑症状以及封锁前和封锁期间偏头痛症状强度和频率的信息。绝大多数是门诊患者（n = 125，88.0%），52名（36.6%）有先兆偏头痛，而90名（63.4%）有无先兆偏头痛。所有在新冠疫情之前报告症状进展恶化的患者，在封锁期间症状强度均有所降低（χ² = 31.05，P < 0.0001）。在封锁前症状恶化的患者中，50%观察到症状频率降低，症状稳定的患者中45%观察到症状频率降低，症状已在改善的患者中12%观察到症状频率降低。所有在新冠疫情之前症状已缓解的患者在封锁期间症状稳定（χ² = 38.66，P < 0.0001）。焦虑症状与更高的偏头痛症状频率显著相关（χ² = 19.69，P < 0.001）。对有先兆和无先兆个体分别重复分析并未影响研究结果，两个患者亚组均证实了显著相关性。在意大利北部新冠疫情封锁阶段，小儿患者的偏头痛症状强度和频率显著降低。偏头痛症状强度和频率的改善在封锁前症状稳定或恶化的患者中尤为显著。在环境挑战和压力减少的时期症状严重程度降低，进一步凸显了为这些患者提供有效压力调节和应对训练的必要性。
