Uyar Cankay Tugba, Besenek Mert
Department of Neurology, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey.
Department of Child and Adolescent Psychiatry, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey.
BMC Neurol. 2021 Mar 3;21(1):97. doi: 10.1186/s12883-021-02119-6.
Chronic migraine is a condition with gradually increasing prevalence among adolescents which causes severe headaches resulting in functionality loss. Factors contributing to migraine becoming chronic and negatively affecting quality of life in adolescence are still unclear. Parallel with these, we aimed to examine the effect of psychiatric symptoms on headache severity and functionality loss among adolescents with chronic migraine.
We evaluated features of 50 adolescents who were diagnosed with chronic migraine according to International Classification of Headache Disorders-3 for the first time in their lives by an experienced neurologist. Sociodemographic and clinical data were collected and Pediatric Migraine Disability Assessment Score, Visual Analogue Score and DSM-5 Level 1 Cross-Cutting Symptom Measure Scores (CCSM-5) were evaluated. Semi-structured psychiatric interviews were done to those who scored higher than cut-off scores on CCSM-5. Healthy control group was constituted of cases which had similar age and sex distribution to case group.
Majority of the case group was female (%78). There was a positive correlation between headache severity and computerized tomography history in emergency department. All of the psychiatric symptom scores were significantly higher in case group except for psychotic symptoms; but attention problems and manic symptoms clusters did not have significant difference according to the thresholds of CCSM-5. Receiving a psychiatric diagnosis did not affect frequency, severity or duration of headaches. There were also no relationship between depression/anxiety diagnosis and severity of headache/functionality loss.
Findings suggest that; more rational treatment methods with lesser functionality loss should be developed by adopting multidisciplinary and prospective approach via psychiatric screening for adolescents with chronic migraine.
慢性偏头痛在青少年中的患病率逐渐上升，会导致严重头痛并造成功能丧失。导致偏头痛转为慢性并对青少年生活质量产生负面影响的因素仍不明确。与此同时，我们旨在研究精神症状对慢性偏头痛青少年头痛严重程度和功能丧失的影响。
我们评估了50名首次由经验丰富的神经科医生根据《国际头痛疾病分类第三版》诊断为慢性偏头痛的青少年的特征。收集了社会人口统计学和临床数据，并评估了儿童偏头痛残疾评估量表、视觉模拟评分和《精神疾病诊断与统计手册》第五版一级交叉症状测量量表（CCSM-5）评分。对CCSM-5评分高于临界值的患者进行了半结构化精神科访谈。健康对照组由年龄和性别分布与病例组相似的病例组成。
病例组大多数为女性（78%）。急诊室的头痛严重程度与计算机断层扫描病史之间存在正相关。除精神病性症状外，病例组所有精神症状评分均显著更高；但根据CCSM-5的阈值，注意力问题和躁狂症状集群没有显著差异。接受精神科诊断并未影响头痛的频率、严重程度或持续时间。抑郁/焦虑诊断与头痛严重程度/功能丧失之间也没有关系。
研究结果表明，对于慢性偏头痛青少年，应通过精神科筛查采用多学科和前瞻性方法，制定功能丧失较小的更合理治疗方法。
