Attention in Children and Adolescents With Headache
Attention in Children and Adolescents With Headache
Objective.— The previous studies reporting consistent visual reaction times slowing in patients with migraine prompted us to verify if headache could be associated to a broader impairment of attention. This study aims to undertake a thorough investigation of attentional performance by extending the evaluation to children with primary headache of different types.
Methods.— We compared 62 children with headache (14 migraineurs with aura, 29 without aura and 19 with tension type headache) and 52 controls without headache, matched for age, sex, and intelligence using Conners' Continuous Performance Test.
Results.— The 3 clinical groups did not differ in attentional measures. The headache patients, collapsed in 1 single sample, had mean scores in Hit Reaction Time significantly different from those of controls and also had a higher percentage of atypical scores in 2 indices of the Conners' Continuous Performance Test (faster mean reaction time and more commissions).
Conclusions.— Our results confirm the presence of an association between attentional problems and headache that may impact academic learning and daily activities on the long term. The finding that the 3 clinical groups did not show significant differences in attentional performance supports the hypothesis that migraine and tension headache form a continuum that may share the same pathophysiological mechanisms. These results are discussed considering that neurotransmitters and the cerebral circuits subserving headache, personality profile, and attention could overlap, thus predisposing these children to even mild attention malfunctioning.
Headache is a common neurological condition. Although a high prevalence is estimated in adulthood, headache is also frequent in pediatric age groups, increasing progressively from preschool age to adolescence. The diagnostic criteria were classified by the International Headache Society in 1988, but an accurate definition of various forms of headache (for developmental age, too) was provided only by the subsequent revision, proposing a more careful differential diagnosis between migraine and tension headache.
The frequency and chronicity of the disorder have drawn attention not only to the diagnostic and therapeutic issues but also to prognosis, particularly to the possible cognitive and behavioral consequences. However, the findings have been rather contradictory and often scarcely comparable, because of the use of different inclusion criteria and neuropsychological measures.
Numerous studies of adults with migraine showed neuropsychological impairment in tasks such as psychomotor speed, attention, language, verbal and visual memory, and executive functioning. Other studies failed to confirm these results finding no neuropsychological dysfunction in migraineurs (M) compared with controls (C).
On adult tension headache patients (TTH) there is only 1 longitudinal neuropsychological study that identified no cognitive impairments in TTH compared with M and C.
Although numerous studies have investigated the role of clinical variables such as the frequency, duration and intensity of attacks on the neuropsychological performance of M, few have found significant correlation between neuropsychological deficits and higher frequency of attacks or longer history of the disease.
Concerning developmental age, several studies identified an emotional and behavioral profile in children with headache, characterized by a greater prevalence of internalization disorders such as anxiety and mood disorders, whereas only a few (and even then, scarcely conclusive) contributions investigated the headache impact on neurocognitive performance. These studies reported impaired short- and long-delay memory in M vs C; in short-term visual memory and visuomotor integration in M vs TTH; and poor verbal abilities, but normal performance in reading, arithmetic or motor and spatial tasks in M vs TTH and C. Only 1 study compared the cognitive performance of M children with their healthy siblings and found no significant difference in sequential and simultaneous information processing.
In a previous study we assessed general cognition and several neuropsychological functions (short-term auditory and visuospatial memory, visual attention and speed of information processing) in 17 migraineurs with aura (MA) and 31 migraineurs without aura (MoA) children finding that both groups performed within normal range, except for a significant delay in simple reaction times (RT).
Because of the different neuropsychological functions investigated and the different clinical groups considered, the previously referenced works are unable to define specific cognitive profiles in headache patients, but they consistently identified an adequate global intellectual functioning and slower information processing both in M adults and children.
On the basis of previous studies reporting consistent RT slowing in the population with migraine, we hypothesized that headache could be associated to a broader dysregulation of attention. We used the Conners' Continous Performance Test to compare a larger sample of migraineurs with and without aura to children with tension headache and controls.
Abstract and Introduction
Abstract
Objective.— The previous studies reporting consistent visual reaction times slowing in patients with migraine prompted us to verify if headache could be associated to a broader impairment of attention. This study aims to undertake a thorough investigation of attentional performance by extending the evaluation to children with primary headache of different types.
Methods.— We compared 62 children with headache (14 migraineurs with aura, 29 without aura and 19 with tension type headache) and 52 controls without headache, matched for age, sex, and intelligence using Conners' Continuous Performance Test.
Results.— The 3 clinical groups did not differ in attentional measures. The headache patients, collapsed in 1 single sample, had mean scores in Hit Reaction Time significantly different from those of controls and also had a higher percentage of atypical scores in 2 indices of the Conners' Continuous Performance Test (faster mean reaction time and more commissions).
Conclusions.— Our results confirm the presence of an association between attentional problems and headache that may impact academic learning and daily activities on the long term. The finding that the 3 clinical groups did not show significant differences in attentional performance supports the hypothesis that migraine and tension headache form a continuum that may share the same pathophysiological mechanisms. These results are discussed considering that neurotransmitters and the cerebral circuits subserving headache, personality profile, and attention could overlap, thus predisposing these children to even mild attention malfunctioning.
Introduction
Headache is a common neurological condition. Although a high prevalence is estimated in adulthood, headache is also frequent in pediatric age groups, increasing progressively from preschool age to adolescence. The diagnostic criteria were classified by the International Headache Society in 1988, but an accurate definition of various forms of headache (for developmental age, too) was provided only by the subsequent revision, proposing a more careful differential diagnosis between migraine and tension headache.
The frequency and chronicity of the disorder have drawn attention not only to the diagnostic and therapeutic issues but also to prognosis, particularly to the possible cognitive and behavioral consequences. However, the findings have been rather contradictory and often scarcely comparable, because of the use of different inclusion criteria and neuropsychological measures.
Numerous studies of adults with migraine showed neuropsychological impairment in tasks such as psychomotor speed, attention, language, verbal and visual memory, and executive functioning. Other studies failed to confirm these results finding no neuropsychological dysfunction in migraineurs (M) compared with controls (C).
On adult tension headache patients (TTH) there is only 1 longitudinal neuropsychological study that identified no cognitive impairments in TTH compared with M and C.
Although numerous studies have investigated the role of clinical variables such as the frequency, duration and intensity of attacks on the neuropsychological performance of M, few have found significant correlation between neuropsychological deficits and higher frequency of attacks or longer history of the disease.
Concerning developmental age, several studies identified an emotional and behavioral profile in children with headache, characterized by a greater prevalence of internalization disorders such as anxiety and mood disorders, whereas only a few (and even then, scarcely conclusive) contributions investigated the headache impact on neurocognitive performance. These studies reported impaired short- and long-delay memory in M vs C; in short-term visual memory and visuomotor integration in M vs TTH; and poor verbal abilities, but normal performance in reading, arithmetic or motor and spatial tasks in M vs TTH and C. Only 1 study compared the cognitive performance of M children with their healthy siblings and found no significant difference in sequential and simultaneous information processing.
In a previous study we assessed general cognition and several neuropsychological functions (short-term auditory and visuospatial memory, visual attention and speed of information processing) in 17 migraineurs with aura (MA) and 31 migraineurs without aura (MoA) children finding that both groups performed within normal range, except for a significant delay in simple reaction times (RT).
Because of the different neuropsychological functions investigated and the different clinical groups considered, the previously referenced works are unable to define specific cognitive profiles in headache patients, but they consistently identified an adequate global intellectual functioning and slower information processing both in M adults and children.
On the basis of previous studies reporting consistent RT slowing in the population with migraine, we hypothesized that headache could be associated to a broader dysregulation of attention. We used the Conners' Continous Performance Test to compare a larger sample of migraineurs with and without aura to children with tension headache and controls.