Psychosomatic assessment of preadolescentswith tension type headache

This research was concentrated on a group of 36 out-patients, selected as suffering from ôfunctionalö migraine-like headache, mean age 10.8 (▒ 1.74) years, of both sexes. Their clinical results (neurological, neurophysiological, radiological and laboratory) were normal, suggesting psychosomatic etiology. The characteristics of the headache correspond to a nosographic entity known as tension-type headache. The aim of this study was to evaluate the psychological characteristics of these children and their families, especially the profile of the mothers. The psychological assessment consecutively applied comprised: EPQ (Eysenck Personality Questionnaire), EPI (Emotional Profile Index), STAI (State-Trait Anxiety Inventory), and HVR (Human Values Rank). The mothers were examined by FILE (Family Inventory Life Events) and MMPI.
The results obtained showed a non negligible level of actual anxiety in all the children, who were mostly the first born, and lived in families with accentuated stress.
Headache is a common type of somatization phenomena in children. The evaluation of the patient with headache must be very careful because of the great number of etiologic moments. Most of the children cannot communicate the characteristics of the headache and rather become irritable. Therefore, the anamnestic data and clinical evaluation are very important (1, 2).
Diagnostics of migraine-like headaches in childhood differ. In 1988 the IHS (International Headache Society) gave new criteria for diagnostics, mainly based on the presence of aura (3).
Table 1 presents diagnostic criteria for two type of headache in children.
Table 2 presents the classification of migraine syndromes On Table 3. Criteria for tension-type headache are present.
Tension-type headache is one of the most diffuse disorders. It is thought to affect about 3% of the general population almost every day and about 10% once a week (4). It is estimated that in about 78% of the general population once in the life cycle a tension type headache occurs. The onset of this type of headache is often related to acute or chronic stress. A tension type headache is currently described as a form of recurrent episodic form of headache lasting from a few minutes to days with a compressive-constrictive type of pain, non-pulsating, of mild to moderate intensity, bilateral, not worsened by physical activity. Nausea, photophobia and phonophobia may also co-exist.
We evaluated a group of children manifesting tension-type headaches.
The aim of this study was:
to examine the psychological characteristics of these children
to correlate their characteristics with their mothers' personalities
to evaluate their family environment
SAMPLE AND METHODOLOGY
We randomly chose children complaining of headaches corresponding clinically to the classical tension type headache. The examined sample comprised 36 out-patients, of a mean age of 10.8 ( ± 1.74) years.
Three levels of evaluation were performed:
Clinical evaluation
Headache assessment questionnaire (adapted questionnaire by M. Biondi)
Psychological evaluation
Clinical examinations as well as neurophysiological, radiological, ophthalmologic and laboratory data were normal. All children were primary school pupils.
Psychological assessment comprised:
For children :
EPQ ( Eysenck Personality Questionnaire)
EPI ( Emotional Profile Index)
STAI (State-Trait Anxiety Inventory)
HVR (Human Values Rank)
For the mothers:
FILE (Family Inventory Life Events)
MMPI ( Minnesota Multiphasic Personality Inventory)
EPQ (5, 6) was chosen to examine the four classical characteristics of the personality: extroversion/introversion;
neurotism/emotional stability; psychopatology and l- values corresponding to dissimulation or social adaptability, as well as lye level. Previous experience with this psychometric instrument in our population has confirmed the validity, reliability and discriminativity of the results obtained (7, 8, 9).
EPI (10) was chosen to evaluate the emotional structure of the patients in correlation with their personal characteristics. The basic theoretical concept of the test is the hypothesis that personality traits are the result of primary emotions and emotional states (Kellerman 1964, Kellerman and Plutchnik, 1968).
The person in question chose one of the possible personality traits in relation to the emotional disposition. The emotional profile obtained shows the main conflictual area of the person (11, 12).
The STAI (State-Trait Anxiety Inventory) is very simple questionnaire chosen to show the child’s actual anxiety. The anxiety is correlated with fear of many situations, persons , objects etc (13).
Human Values Rank is a relatively new psychometric instrument in our clinical work with children and helps us in the diagnostics of the motivation structure of the personality. The rank of the values corresponds to basic needs and express the super-ego structure (14, 15).
With this psychological evaluation of the children we hope to find the main characteristics of the personality, conflicts and situations which influence the somatization phenomena.
In pediatric practice the personality of the mother is of great interest. In many psychosomatic conditions mothers are responsible for the provoking the actual problem in their children.
In our study of migraine-like headaches, we chose FILE (Family Inventory Events) as a main index of the family situation (16, 17), as well as MMPI- as a relevant test for the personality profile of the mothers (18, 19). With this two instruments we may evaluate the influence of mother as the most important personality to influence the children’s stability, on the stability of the whole family group, as well as the complexity of the family situation as stressful provocation of the disease.