Parental catastrophizing about their child's pain. The parent version of the Pain Catastrophizing Scale (PCS-P): a preliminary validation

Numerous studies have found evidence for the role of catastrophizing about pain in adjustment to pain in both adults and children. However, the social context influencing pain and pain behaviour has been largely ignored. Especially in understanding the complexities of childhood pain, family processes may be of major importance. In line with the crucial role of pain catastrophizing in explaining adjustment and disability in adults and children, this study investigates the role of parental catastrophic thinking about their child's pain in explaining child disability and parental distress. To study parental catastrophizing, a parent version of the Pain Catastrophizing Scale (PCS-P) was developed. An oblique three-factor structure emerged to best fit the data in both a sample of parents of schoolchildren (N=205) and in a sample of parents of children with chronic pain (N=107). Moreover, this three-factor structure was found to be invariant across both parent samples. Further, in the clinical sample, parents' catastrophic thinking about their child's pain had a significant contribution in explaining (a) childhood illness-related parenting stress, parental depression and anxiety, and (b) the child's disability and school attendance, beyond the child's pain intensity.     

Quality of life,coping strategies,and family routines in children with headache

OBJECTIVE: To identify the relationship between headache severity, child coping, and quality of life (QoL) in the context of everyday family life. BACKGROUND: In the pediatric headache research only 3 studies have examined children's coping strategies and only 4 studies considered QoL. METHODS: A sample of 48 Italian families with children seeking treatment for primary headaches was interviewed using an adaptation of the Ecocultural Family Interview (EFI). The EFI is a parent interview that explores the daily routines of family life in which the child and parent participate and the main concerns regarding how that routine is organized. RESULTS: As expected the Lisrel analyses consistently showed that QoL is affected by a child's coping abilities in a causal direction. Headache frequency and duration have a significant impact on a child's QoL. The family daily routine influences significantly both the child's coping ability and QoL. Surprisingly enough, children's coping strategies are not related to headache severity. CONCLUSIONS: More research is needed on the causal factors influencing child's ability to cope with pain, and in particular more attention should be devoted to the contextual and family factors related to pediatric headache.     

Osmophobia in primary headaches

This study evaluates osmophobia (defined as an unpleasant perception, during a headache attack, of odours that are non–aversive or even pleasurable outside the attacks) in connection with the diagnosis of primary headaches. We recruited 775 patients from our Headache Centre (566 females, 209 males; age 38±12 years), of whom 477 were migraineurs without aura (MO), 92 with aura (MA), 135 had episodic tension–type headache (ETTH), 44 episodic cluster headache (ECH), 2 chronic paroxysmal hemicrania (CPH) and 25 other primary headaches (OPHs: 12 primary stabbing headaches, 2 primary cough headaches, 3 primary exertional headaches, 2 primary headaches associated with sexual activity, 3 hypnic headaches, 2 primary thunderclap headaches and 1 hemicrania continua). Among them, 43% with MO (205/477), 39% with MA (36/92), and 7% with CH (3/44) reported osmophobia during the attacks; none of the 135 ETTH and 25 OPH patients suffered this symptom. We conclude that osmophobia is a very specific marker to discriminate adequately between migraine (MO and MA) and ETTH; moreover, from this limited series it seems to be a good discriminant also for OPHs, and for CH patients not sharing neurovegetative symptoms with migraine. Therefore, osmophobia should be considered a good candidate as a new criterion for the diagnosis of migraine.     

Ophthalmoplegia With Migraine in Adults: Is It Ophthalmoplegic Migraine?

Objective.— Ophthalmoplegic migraine (OM) is a rare disorder characterized by recurrent oculomotor nerve palsy in children, following migraine headaches. We report 62 adults, seen consecutively, who developed acute ophthalmoplegia with severe attacks of migraine over a 10-year (1996-2005) period. An overwhelming majority of these patients had an antecedent worsening in severity of migraine headaches, before the ophthalmoplegic attack.
Methods.— Sixty-two patients, aged 15-68 years, with an acute attack of OM underwent detailed clinical, biochemical, and neuroradiological evaluation.
Results.— There were 62 patients with 86 attacks of OM. Whereas 48 patients had a single attack, 14 had 2 or more attacks, fulfilling the International Headache Society criteria for probable and definite OM, respectively. At presentation, isolated abducens, oculomotor, and trochlear nerve involvements were seen in 35 (56.5%), 21 (33.9%), and 5 (8.1%) patients, respectively. One patient had simultaneous involvement of 3rd and 6th nerves. Fifty-one (82.3%) patients exhibited an antecedent worsening in severity of migraine, before developing ophthalmoplegia during (59/95.2%) or within 24 hours (3/4.8%) of a severe migraine attack, respectively. Detailed biochemistry and cranial neuroimaging were normal. No case had any nerve enhancement. Use of steroids hastened recovery ( P  < .05).
Conclusion.— We conclude: (1) OM in adults is characterized by single attacks of ophthalmoplegia in a great majority of patients; and (2) 6th nerve involvement occurs commonly. Our results indicate that moving OM to the chapter on cranial neuralgias in the second edition of the International Headache Classification may be premature, since nerve palsy occurred during a severe migraine attack in all patients.     

Pain-relieving factors in migraine and tension-type headache

We performed the present study to compare patients with migraine and tension-type headache (TTH) in their behaviour during the attacks and the manoeuvres to relieve the pain. One hundred thirty consecutive patients with either migraine (n = 75) or TTH (n = 55) were questioned (including the use of a checklist) concerning their usual behaviour during the attacks and non-pharmacological manoeuvres performed to relieve the pain. The results of the two types of headache were compared. Patients with migraine tended to perform more manoeuvres than patients with TTH (mean: 4.3 vs. 3.6). These manoeuvres included pressing and applying cold stimuli to the painful site, trying to sleep, changing posture, sitting or reclining in bed (using more pillows than usual to lay down), isolating themselves, using symptomatic medication, inducing vomiting, changing diet and becoming immobile during the attacks. The only measure predominantly reported by patients with TTH was scalp massage. Migraineurs, compared to patients with TTH, changing eating habits, pressed the pain site; there were no significant differences between the two groups. The behaviour of patients during headache attacks varies with the diagnosis. Measures that do not always result in pain relief are performed in order to prevent its worsening or to improve associated symptoms. These behavioural differences may be because of the different pathogenesis of the attacks or of various styles of dealing with the pain. They can also aid the differential diagnosis between headaches in doubtful cases.     

Efficacy and safety of tonabersat, a gap-junction modulator, in the acute treatment of migraine: a double-blind, parallel-group, randomized study

The ability of tonabersat to relieve the symptoms of migraine attacks with or without aura was evaluated in a randomized, double-blind, placebo-controlled, multicentre, parallel-group study. Patients received 20 or 40 mg of tonabersat, or 50 mg of sumatriptan (positive control), or placebo at the onset of a moderate or severe attack. Headache intensity, relief and recurrence were recorded for 24 h after dosing. On the basis of primary or secondary efficacy measures, tonabersat did not provide a clinically or statistically significant advantage over placebo. Tonabersat generally was well tolerated and had no effect on vital signs, electrocardiogram recordings or laboratory values. The lack of efficacy may be a function of the slow absorption of tonabersat. As a consequence of slow absorption, daily administration of tonabersat as prophylaxis for migraine attacks is under investigation in ongoing studies.     

Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache

Objectives.— Chronic cluster headache patients are often resistant to pharmacological management. Percutaneous radiofrequency ablation (RFA) of the sphenopalatine ganglion (SPG) was shown before to improve episodic cluster headache but not chronic cluster headache. We were interested to examine the effect of such intervention in patients with intractable chronic cluster headache who failed pharmacological management.
Methods.— Fifteen patients with chronic cluster headache, who experienced temporary pain relief following SPG block, underwent percutaneous RFA via the infrazygomatic approach under fluoroscopic guidance. Collected data include demographic variables, onset and duration of the headache, mean attack intensity (MAI), mean attack frequency (MAF), and pain disability index (PDI) before and up to 18 months after procedure.
Results.— At 1-, 3-, 6-, 12-, 18-month follow-up, the MAI was 2.6, 3.2, 3.2, 3.4, 4.2, respectively ( P  < .0001, P  < .0001, P  < .0001, P  < .0005, P  < .003, respectively). The PDI improved from 55 (baseline) to 17.2 and 25.6 at 6 and 12 months respectively ( P  < .001). The MAF improved from 17 attacks/week to 5.4, 6.4, 7.8, 8.6, 8.3 at 1-, 3-, 6-, 12-, 18-month follow-up visits ( P  < .0001, P  < .0001, P  < .0001, P  < .002, P  < .004, respectively).
Conclusion.— Our data showed that percutaneous RFA of the SPG is an effective modality of treatment for patients with intractable chronic cluster headaches. Precise needle placement with the use of real-time fluoroscopy and electrical stimulation prior to attempting radiofrequency lesioning may reduce the incidence of adverse events.     

Parent's involvement in decisions when their child is admitted to hospital with suspected shunt malfunction: study protocol

Title.  Parent's involvement in decisions when their child is admitted to hospital with suspected shunt malfunction: study protocol.
Aim.  This paper outlines the protocol for a study aimed at exploring parent's involvement during professional–parent interactions and decisions about their child's care in the context of suspected shunt malfunction.
Background.  Hydrocephalus is a long-term condition treated primarily by the insertion of a shunt that diverts fluid from the brain to another body compartment. Shunts frequently malfunction, and parents of children with shunted hydrocephalus are responsible for recognizing and responding to shunt complications. Parents feel that interactions with professionals when they seek healthcare advice for their child do always not encourage active participation in care decisions.
Methods.  The study design is based on qualitative methodologies: a combination of conversation analysis applied to consultation recordings of professional–parent interactions when a child is admitted to hospital with suspected shunt malfunction, and semi-structured follow-up interviews with the same participants within 2 weeks of the consultation.
Participants.  This is a prospective study and participants will be purposefully selected. Parents of children who have been admitted to hospital with suspected shunt malfunction and healthcare professionals responsible for the initial assessment of the child will be invited to participate.
Discussion.  The study will identify how decisions about a child's care are negotiated between parents and healthcare professionals at key stages of the care pathway. In addition, examining interactions between healthcare professionals and parents may identify approaches that support or hinder parents in contributing to the decision-making processes when they seek advice from healthcare professionals.     

Plasma calcitonin gene-related peptide in diagnosing and predicting paediatric migraine

To investigate the role of plasma calcitonin gene-related peptide (CGRP) in paediatric migraine, we prospectively collected 134 blood samples during or between attacks from 66 migraine, 33 non-migraine headache (non-migraine) and 22 non-headache patients, aged 4–18 years. Plasma CGRP concentrations were measured by enzyme-linked immunosorbent assay and disability by Pediatric MIgraine Disability ASsessment (PedMIDAS) questionnaire. Migraineurs had higher plasma CGRP levels than non-migraine patients ( P  = 0.007). The attack level was higher than the non-attack level in migraine ( P  = 0.036), but not in non-migraine, patients. This was also revealed in paired comparison ( n  = 9, P  = 0.015 vs. n  = 4, P  = 0.47). Using a threshold of 55.1 pg/ml, the sensitivity of the attack level in predicting migraine was 0.81, and specificity 0.75. The PedMIDAS score tended to be higher in the high CGRP (> 200 pg/ml, n  = 7) group than in the low (< 200 pg/ml, n  = 33) group (26.07 vs. 19.32, P  = 0.16) using Mann–Whitney test. Plasma CGRP is useful for diagnosis in paediatric migraine.     

Psychosocial Experiences of Parents of a Child With Imperforate Anus

PURPOSE.  This study aims to examine the psychosocial experiences of parents of children with imperforate anus (IA) and to describe their potential positive experiences.
DESIGN AND METHODS.  Parents of IA children and a comparison group answered a questionnaire, which was analyzed quantitatively and with manifest content analysis.
RESULTS.  Social relationships and respect for the child's will were more affected among IA mothers. Positive experiences were revealed in relation to the child, the parent, and the family.
PRACTICE IMPLICATIONS.  Support to parents in caring for a child with IA should be individualized and occasionally undertaken through collaboration with experts from child and adolescent psychiatry.     

Parents' perceptions of children with chronic illness: a study of immigrant Chinese families

This article describes and discusses parents' perceptions of a children with a long-term health problems in 16 Chinese immigrant families and 15 Euro-Canadian families. These data are part of a larger study, the purpose of which was to explore the illness experience and help-seeking behavior of these families. The data show that the Euro-Canadian parents see the illness or disability as affecting only particular aspects of the child's life, while the child as a whole is seen as normal. The Chinese parents more frequently describe the illness as having global effects on many aspects of the child's present and future life. These differences in perception are discussed in relation to literature about Chinese culture and the experience of immigration. It is suggested that how a parent perceives a child's illness affects how a parent cares for the child and interacts with health care providers.     

Blood Pressure Changes in Migraine Patients before,during and after Migraine Attacks

Migraine attacks are characterized by headaches associated with neurological, gastrointestinal, and autonomic symptoms. A relationship between migraine and hypertension or hypotension is controversial. In this study, we aimed to determine if blood pressure changes were related to migraine attacks. From the outpatient clinic of our neurology department, 62 normotensive migraine patients with and without aura were chosen for study in accordance with the International Headache Society 2004 criteria. A questionnaire including general and specific questions was given to the patients to be filled out during 6 consequent migraine attacks. The patients received a fully automatic digital brachial upper arm sphygmomanometer (Omron M 4‐1) to measure the changes in their blood pressure during attacks. The patients were asked to record their blood pressure changes 3 times: (1) just before or very early, (2) during (when headache peaks), and (3) 1 hour after the attack. Twenty‐three of the 62 patients (57 women, 5 men) had migraine with aura (22 women and 1 man), and 39 of them did not have aura (35 women and 4 men). There was no statistically significant difference between systolic and diastolic values obtained before or very early, during the peak level, and 1 hour after the end of the attacks (P > 0.05). Although diastolic hypotensive values were not different statistically between groups, when all the patients were considered, diastolic hypotensive values were detected in a considerable number of patients (a total of 115 measurements). In this normotensive migrainous population, we observed that diastolic hypotension before or very early, during, and after migraine attack was the most significant result (5.1%). Although it was not statistically significant, the total number of hypotensive values was remarkable.     

Use of the Migraine Disability Assessment Questionnaire in children and adolescents with headache: an Italian pilot study

OBJECTIVES: To determine the suitability of the Migraine Disability Assessment (MIDAS) Questionnaire for assessing disability in children and adolescents with headache and to obtain preliminary information about disability in different primary headaches. BACKGROUND: During the last decade, researchers have begun to employ standardized methodologies to investigate the global impact of primary headaches. Disease-specific instruments have been developed to measure headache-related disability. The MIDAS Questionnaire, which is the most extensively studied of these instruments, was designed to assess the overall impact of headaches over the 3 months before compilation. The MIDAS Questionnaire is an optimal tool to assess headache-related disability in adults. METHODS: Ninety-five patients aged 7 to 17 years with tension-type headache, migraine, or both completed the validated Italian form of the MIDAS questionnaire on 2 occasions. Test-retest reliability was assessed by the Spearman rank correlation test. The Cronbach alpha assessed internal consistency. The patients answered questions about the adequacy of the questionnaire. RESULTS: The Cronbach alpha was.8. Correlation coefficients were generally high for the overall MIDAS score and for the items investigating disability in school and in family/leisure activities; they were lower for the items about housework. Most patients thought that the MIDAS Questionnaire was useful (98.9%) and that it captured the impact of their headaches (58.9%); 41% thought that questions about disability in housework were useless, 44.2% suggested adding questions regarding inability to do homework. All primary headaches had a considerable impact on daily activities, but patients with migraine tended to have lower headache frequencies and lower total disability time; those with tension-type headache suffered more days in which activities, although performed, were substantially impaired. CONCLUSIONS: The MIDAS Questionnaire is useful for assessing disability in children and adolescents with different primary headaches. Minimal changes in the phrasing and content of the items would be sufficient to render the MIDAS specific for the younger population with headache.     

Migrainous corpalgia: body pain and allodynia associated with migraine attacks

Cephalic and extracephalic allodynia are recognized as a common sign of sensory sensitization during migraine episodes. However, the occurrence of body pain in migraine has not been thoroughly explored. Here we report three patients presenting with spontaneous body pain in association with migraine attacks. A 41-year-old woman experienced face and limb pain along with migraine headaches; it started before, during or after headache, was usually ipsilateral to head pain, and could last from minutes to days. A 39-year-old woman had pain in her right limbs, back and neck for 30–60 min prior to right-sided migraine headaches. A 30-year-old woman perceived pain in her left upper limb for 24–48 h prior to left-sided migraine headaches. All patients had allodynia to mechanical stimuli over the painful areas. Spontaneous body pain may be associated with migraine attacks. Together with allodynia, this might be a consequence of central sensitization.     

Ictal and interictal phonophobia in migraine—a quantitative controlled study

The aim of the study was to evaluate quantitatively ictal and interictal phonophobia in episodic migraine (EM). We included subjects with EM and age- and gender-matched controls. Sound stimuli were pure tones at frequencies of 1000, 4000 and 8000 Hz. Sound aversion thresholds (SATs) were determined as the minimal sound intensity perceived as unpleasant or painful. Migraineurs were examined both between and during attacks. We compared interictal SATs in migraineurs with those in controls. We also compared ictal and interictal SATs in migraineurs. Sixty migraineurs and 52 controls were included. Interictal mean SAT of migraineurs, averaged for the three frequencies, was significantly lower than that of controls [90.4 (0.8) dB vs. 105.9 (1.1) dB, respectively, P  < 0.0001]. In migraineurs, mean ictal SAT, averaged for the three frequencies, was significantly lower than interictal SAT [76.0 (0.9) dB vs. 91.0 (0.8) dB, respectively, P  < 0.0001]. Patients with EM exhibit increased sound aversion between attacks that is further augmented during an acute attack.     

Hemicrania continua: a third case in which attacks alternate sides

Hemicrania continua (HC) is an uncommon, primary headache disorder characterized by a continuous unilateral headache of moderate intensity with superimposed exacerbations of more severe pain. HC exists in two temporal subtypes, a continuous form in which headaches persist continuously without remission periods, and a less common remitting form in which bouts of continuous headaches are separated by pain-free remissions. There have been more than 100 prior reports of HC; in the majority of which the headache is strictly unilateral and without side shift. We now report the third patient in whom headaches alternated sides during different attacks.     

Kinesiophobia in migraine.

Pain aggravation by movement and avoidance of movement (kinesiophobia) is often reported by patients during migraine attacks. Yet its specific contribution to migraine diagnosis is undetermined. To characterize the frequency and severity of kinesiophobia during migraine and its role in the diagnosis of primary headaches, we questioned 150 patients (126 women and 24 men, average age 38.5 yrs) with migraine (n = 111) or tension-type headache (TTH) (n = 39) about aggravation of pain by bending forward, brisk head movements (jolt), and avoidance of movement during the attacks. The degree of pain worsening by each stimulus was measured through a visual analog scale and compared to worsening produced by other sensory stimuli such as light, sound, and smell. The discrimination power of kinesiophobia between migraine and TTH was calculated, using the International Classification of Headache Disorders criteria as gold standard. Sensitivity/specificity of studied symptoms was high in differentiating the 2 headache types: bending forward: 98%/85.7%; jolt: 96.3%/81.6%; and immobility during the attacks: 100%/70%. The degree of kinesiophobia was identical to photo- and phonophobia in migraine patients. We conclude that kinesiophobia discriminates between migraine and TTH. Bending forward and jolt may be useful additional questions to ask patients for the differentiation of headache attacks. PERSPECTIVE: This article evaluates the specific role of movement (movement-induced pain aggravation and avoidance of movement) in primary headaches. Kinesophobia is an easy symptom to screen, explained by migraine pathophysiology, and proved to be a sensitive and specific measure to identify migraine attacks when compared to tension-type headache.     

The associations between headaches and psychopathology: a survey in school children

(Headache 2010;50:1537‐1548) Background.— Headaches are common in childhood and significantly impact children's quality of life. On the contrary to the adolescent and adult population, there are few data on the associations between headaches and psychopathology in young children. Objective.— The aim of this study was to examine the relationships between child headaches, emotional and behavioral difficulties in children aged 6‐11 years old. Methods.— A cross‐sectional survey was conducted in 2004 in 100 primary schools from a large French region, with 2341 children aged 6‐11 years old randomly selected. Child headache status, comorbid physical conditions, and socioeconomic characteristics were collected in parent‐administered questionnaires. Child psychopathology outcomes were assessed using child‐ and parent‐reported standardized instruments: respectively, the Dominic Interactive and the Strengths and the Difficulties Questionnaire. Associations were estimated using logistic regression models. Results.— Response rates to the parent questionnaire and the Dominic Interactive were 57.4% and 95.1%, respectively. The final sample size was 1308 children. Eleven percent of the children already experienced frequent headaches in their lifetime, with no difference by age or gender. Headaches were associated with parent‐reported emotional problems (OR = 1.76; 95% CI: 1.03‐3.01) and self‐reported general anxiety disorder (OR = 1.99; 1.13‐3.52). Comorbid physical conditions ≥2 appeared as an independent factor significantly associated with headaches (OR = 1.75; 95% CI: 1.13‐2.73). Inversely, low parental punitive behaviors were less frequently associated with headaches (OR = 0.41; 95% CI: 0.18‐0.94). Conclusion.— Our results suggest some associations between headaches, emotional disorders, and comorbid physical conditions in young children aged 6‐11 years old. Those results should be considered in the treatment approaches of childhood headaches and from the etiological aspect.