Migraine in childhood: an organic, biobehavioral, or psychosomatic disorder?

DOI: https://doi.org/10.1007/s10072-019-03827-1

Abstract-Summary There are several factors underlying the onset and the maintenance of this disorder and there is still no a clear etiopathogenesis common to all subjects suffering from migraine.

Psychological factors such as individual characteristics, psychiatric comorbidi- ties, and temperament are strictly related to psychosomatic disorders and to migraine.

The environmental influence is very relevant and studied: socio-economic status, family dysfunctions, attachment style, or psychiatric disease in parents can influ- ence the onset of migraine in children.

Introduction Children quality of life is strongly influenced by pain severity and degree of dis- ability of headache or migraine [619].

Several studies have emphasized the role of different risk factors for migraine in

children.

It has been verified that there is a mutual pathogenetic link between migraine and psychological, social and biological factors and all of them can influence the indi- vidual homeostasis and cause migraine.

The aim of this review is to analyze recent evidences on biological and psycho-

logical factors that may cause migraine in childhood and adolescence.

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Neural, Biological, and Genetic Factors Several fMRI studies on migraine patients suggested an association with cortical functional alteration.

A study [620] in which it has been used a 3 T MRI scans during the initial 6 hr of a spontaneous migraine attack, there were compared 13 adults with migraine without aura with a group of 19 healthy volunteers to assess resting state data in the four core regions of the DMN: medial prefrontal cortex (MPFC), posterior cingulate cortex (PCC), and left and right inferior parietal lobules (IPLs), as well as in bilat- eral insula.

Starting from these evidences on brain abnormalities, some studies aimed to ana-

lyzed cognitive impairment in migraine patients, both children and adults.

Few studies on children with migraine reported cognitive changes [621–623] and the most frequent were as follows: memory impairment, attention deficit, and reduc- tion in information processing speed.

Psychological, Familiar, and Environmental Factors Extremely stressful events in childhood and adolescence can be experiences like sexual, physical and psychological abuse, separation and divorce, or neglect and they have been identified as risk factors for migraine and its chronicity [624, 625].

Some studies that assessed psychiatric and psychological comorbidity in chil- dren and adolescents with migraine, outline a psychological profile of these patients.

Most of children and adolescents with migraine have similar psychological characteristic which can influence the onset, maintenance, and outcome of migraine.

In a recent retrospective cohort study conducted by Eidlitz-Markus T and Zeharia A [626], it has been seen that age at migraine onset in children and adolescents was significantly lower in those with a history of maternal or paternal migraine than in their mothers or fathers.

Another study [627] demonstrated a significant association between migraine

without aura and anxiety symptoms in childhood and adolescence.

Conclusions Although there are many studies investigating the possible causes of migraine, there are still few evidences in childhood and adolescence.

Psychological, environmental, and biological factors interact with each other,

predisposing the subject to develop migraine.

The study of only genetic predisposition or environmental factors could lead to partial conclusions and compromise the understanding of the complexity of the problem.

Acknowledgement A machine generated summary based on the work of Guidetti, Vincenzo; Cerutti, Rita; Faedda, Noemi; Natalucci, Giulia. 2019 in Neurological Sciences.

4.9 Childhood and Adolescent

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The use of nutraceutics in children‘s and adolescent’s headache