NEW YORK (Reuters Health) Jul 15 - Contrary to common belief, children treated for migraine are not more likely to be psychologically maladjusted, according to a systematic review published online July 5th in Pediatrics.
They do tend to have more somatic complaints, however, and to show more internalizing behavior, which is likely due to their symptoms and not the consequence of psychological dysfunction, the researchers say.
In their search of Medline, Embase, PsycINFO, and the Cochrane Database, first author Dr. Jacques Bruijn from Vlietland Hospital, Schiedam, the Netherlands, and colleagues identified seven case-controlled studies of psychological functioning and/or psychiatric comorbidity in children or adolescents with migraine. Altogether the studies involved 268 migraine patients (mean age, 11.7 years).
The authors grouped the 26 different standardized outcome measures according to the 10 outcome fields in the Child Behavior Check List (i.e., withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behavior, aggressive behavior, internalizing behavior, and externalizing behavior).
While the investigators reported that children with migraines had more somatic complaints and internalizing behavior compared to controls, they also found strong evidence that these children do not have more thought problems, social problems, or exhibit more withdrawn, delinquent or aggressive behavior than healthy children.
Evidence for anxiety, depression, attention problems, or externalizing behavior was inconclusive.
Pediatric migraine seemed to be associated with more frequent diagnoses of oppositional defiant disorder, but not attention deficit/hyperactivity disorder, conduct disorder, or dysthymia - but this evidence was limited.
Five of the studies were high-quality, but the authors note that all seven were small, and none used a random selection strategy.
The researchers conclude that in general, children with migraine don't need referral to a child psychologist or psychiatrist. If psychological or psychiatric problems do exist, however, they believe mental health referral is likely to have long-term benefits for the children's migraines as well.
SOURCE: http://link.reuters.com/xak47m
Pediatrics 2010.
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