Attachment Characteristics of Children with Primary Headache and Their Mothers, and Comparison of Psychiatric Comorbidity and Intelligence Levels of the Children
Year 2025,
Volume: 32 Issue: 3, 218 - 228, 09.09.2025
Perihan Çam Ray
,
Gonca Gül
,
Sunay Firat
,
Serhat Nasıroğlu
,
Faruk Incecik
,
Ayşegül Yolga Tahiroğlu
,
Adnan Barutçu
Abstract
Objective: This observational study aimed to investigate comorbid psychiatric disorders and patterns of attachment among children and adolescents diagnosed with primary headaches. We also aimed to study the relationship between maternal attachment and headache.
Material and Method: The study included 34 patients (50% girls) aged 6-16 years (mean age = 10.8 ± 2.3 years) who were under the care of pediatric clinics, as well as their 34 mothers. Psychiatric disorders were evaluated among the participants using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Diagnosis of primary headaches in accordance with the requirements of the International Classification of Headache Disorders, second edition. The child participants were assessed using the Short Form of the Inventory of Parent and Peer Attachment (IPPA) and the Wechsler Intelligence Scale for Children- Revised Intelligence Quotient (WISC-R IQ), and their mothers completed the Experiences in Close Relationships (ECR) Inventory and Symptom Check List-90-Revised (SCL-90-R).
Results: The results of the neurological assessments of the children with headache showed that 20 were diagnosed with migraine, 9 were diagnosed with other primary headache, and 5 were diagnosed with tension-type headache. The mean scores of the children were 66.2±11.7 on IPPA (mother), and 62.6±11.7 on IPPA (father), and the mean scores of the mother were 66.1±15.0 on ECR (avoidance), 66.7±16.7 on ECR (anxious). No significant differences were observed in these scales according to headache subtype. According to the results of the psychiatric evaluations, specific learning disability, attention deficit-hyperactivity disorder, phobias, and separation anxiety were found the most frequently, and in the comparisons made between the frequencies of mental diagnoses in the children and those in the general population. The children had a mean overall WISC-R IQ score of 96.4 ±15.0, which indicated normal intelligence. There were no significant differences in psychiatric comorbidity rates or WISC-R IQ mean scores according to headache subtype.
Conclusion: Children with headaches should be evaluated by a psychiatrist and neurologist and treated accordingly.
Ethical Statement
Ethical approval was obtained from the Ethics Committee of Non-Interventional Research of Çukurova University with the decision dated 30.06.2011 and numbered 10/11.
Supporting Institution
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Project Number
Ethical approval was obtained from the Ethics Committee of Non-Interventional Research of Çukurova University with the decision dated 30.06.2011 and numbered 10/11.
References
-
1. Blume, H. K. Childhood headache: A brief review. Pediatric Annals 2017;46(4):155-65.
-
2. Chambers CT, Dol J, Tutelman PR, et al. The prevalence of chronic pain in children and adolescents: A systematic review update and meta-analysis. Pain 2024;165(10):2215-34.
-
3. Onofri A, Pensato U, Rosignoli C, et al. Primary headache epidemiology in children and adolescents: A systematic review and meta-analysis. J Headache Pain 2023;14:24(1):8.
-
4. Özge A, Buğdaycı R, Şaşmaz T, et al. The sensitivity and specificity of the case definition criteria in the diagnosis of headache: A school-based epidemiological study of 5562 children in Mersin. Cephalalgia 2003;23:138-45.
-
5. Karli N, Akiş N, Zarifoğlu M, et al. Headache prevalence in adolescents aged 12 to 17: A student-based epidemiological study in Bursa. Headache 2006;46(4):649-55.
-
6. Salem H, Vivas D, Cao F, et al. ADHD is associated with migraine: A systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2018;27(3):267-77.
-
7. Balottin U, Fusar Poli P, Termine C, et al. Psychopathological symptoms in child and adolescent migraine and tension-type headache: A meta-analysis. Cephalalgia 2013;33(2):112-22.
-
8. Kandemir G, Hesapcioglu ST, Kurt ANC. What are the psychosocial factors associated with migraine in the child? Comorbid psychiatric disorders, family functioning, parenting style, or mom’s psychiatric symptoms? Journal of Child Neurology 2018;33(2):174-81.
-
9. Falla K, Kuziek J, Mahnaz SR, et al. Anxiety and depressive symptoms and disorders in children and adolescents with migraine: A systematic review and meta-analysis. JAMA Pediatr 2022;176(12):1176-87.
-
10. Lee H, Kim S, Chang MC. Associations between headache (migraine and tension-type headache) and psychological symptoms (depression and anxiety) in pediatrics: A systematic review and meta-analysis. Pain Physician 2023;26(6):617-26.
-
11. Bowlby J. Attachment and Loss. 1st ed. London: Hogarth Press; 1969.
-
12. Bowlby J. The Making and Breaking of Affectional Bonds. London: Tavistock Publications; 1979.
-
13. Bowlby, J. Attachment and loss. Vol. 2. Separation: Anxiety and Anger. New York: Basic Books; 1973.
-
14. Weinfield NS, Sroufe LA, Egelend B et al. The nature of individual differences in infant-caregiver attachment. In: Cassidy J, Shaver PR. Handbook of attachment: Theory, research, and clinical applications. New York, The Guilford Press, 1999;66-88.
-
15. Ainsworth MS, Blehar MC, Waters E, et al. Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.;1978.
-
16. Main M, Solomon J. Discovery of a new, insecuredisorganized/disoriented attachment pattern. In: Brazelton TB, Yogman M. Affective Development in Infancy. Norwood, NJ: Ablex; 1986:95-124.
-
17. Tarantino S, De Ranieri C, Dionisi C, et al. Role of the attachment style in determining the association between headache features and psychological symptoms in migraine children and adolescents. An analytical observational case-control study. Headache 2017;57(2):266-75.
-
18. Kozlowska K. Attachment relationships shape pain-signaling behavior. J Pain 2009;10(10):1020-8.
-
19. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders. 2nd edition. Cephalalgia 2004;24(1):9-160.
-
20. Kaufman J, Birmaher B, Brent D, et al. Kiddie-SADS– Present and Lifetime Version (K-SADS-PL). Pittsburgh: University of Pittsburgh School of Medicine; 1996.
-
21. Gokler B, Unal F, Pehlivanturk B, et al. Reliability and validity of schedule for affective disorders and schizophrenia for school-age children–present and lifetime version–Turkish version (K-SADS-PL-T). Turkish J Child Adolesc Ment Health 2004;11:109-16.
-
22. Wechsler, D. Wechsler intelligence scale for children. New York: The Psychological Corporation 1949.
-
23. Wechsler, D. Wechsler intelligence scale for children—revised. New York: Psychological Corporation; 1974.
-
24. Savaşır I, Şahin N. Wechsler çocuklar için zeka ölçeği (WÇZÖ-R) el kitabı. Ankara: Türk Psikologlar Derneği Yayınları; 1995.
-
25. Raja SN, McGee R, Stanton WR. Perceived attachments to parents and peers and psychological well-being in adolescence. Journal of Youth and Adolescence 1992;21:471-85.
-
26. Gunaydin G, Selcuk E, Sumer N, et al. Ebeveyn ve arkadaşlara bağlanma envanteri kısa formunun psikometrik açıdan değerlendirilmesi. Türk Psikoloji Yazıları 2005;8:13-23.
-
27. Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult romantic attachment: An integrative overview. In: JA Simpson, WS Rholes. Attachment Theory and Close Relationships, New York, Guilford Press, 1998; 46-76.
-
28. Sümer N, Güngör D. Yetişkin bağlanma stilleri ölçeklerinin Türk örneklemi üzerinde psikometrik değerlendirilmesi ve kültürlerarası bir karşılaştırma. Türk Psikol Derg 1999;14:71-109.
-
29. Sümer N. Yetişkin bağlanma ölçeklerinin kategoriler ve boyutlar düzeyinde karşlaştırılması. Türk Psikoloji Dergisi 2006;21(57):1-22.
-
30. Derogatis LR. SCL-90-R: Administration, scoring, and procedure manual-I for the revised version. Baltimore: MD Johns Hopkins University School of Medicine, Clinical Psychometrics Unit, 1977.
-
31. Dağ İ. Belirti tarama listesinin (SCL-90-R) üniversite öğrencileri için güvenirliği ve geçerliği. Turk Psikiyatri Derg 1991;2:5-12.
-
32. Bartholomew K, Horowitz LM. Attachment styles among young adults: A test of a four-category model. J Pers Soc Psychol 1991; 61(2):226–44.
-
33. Mikulincer M, Shaver PR. Adult attachment and affect regulation. In: Cassidy J, Shaver P. Handbook of attachment: theory, research, and clinical implications. New York, NY: Guilford Press, 2008; 503–31.
-
34. Berry JK, Drummond PD. Does attachment anxiety increase vulnerability to headache? J Psychosom Res 2014;76(2):113-20.
-
35. Esposito M, Parisi L, Gallai B, et al. Attachment styles in children affected by migraine without aura. Neuropsychiatr Dis Treat 2013;9:1513-9.
-
36. Barone L, Lionetti F, Dellagiulia A, et al. Behavioural problems in children with headache and maternal stress: Is children's attachment security a protective factor? Inf Child Dev 2015;15(6):502-15.
-
37. Bizzi F, Riva A, Charpentier Mora S, et al. Attachment representation to caregivers and mentalizing ability in early adolescents with primary headache. Clin Psychol Psychother 2021;28(4):862-871.
-
38. Tarantino S, Papetti L, De Ranieri C, et al. Maternal alexithymia and attachment style: Which relationship with their children's headache features and psychological profile? Front Neurol 2018;22:8:751.
-
39. Williams R, Leone L, Faedda N, et al. The role of attachment insecurity in the emergence of anxiety symptoms in children and adolescents with migraine: an empirical study. J Headache Pain 2017;18(1):62.
-
40. Mays I, Flynn J, McGuire B, et al. The role of attachment style, adverse childhood experiences, and dissociation in migraine. J Trauma Dissociation 2022;23(3):245-278.
-
41. Öztop DB, Taşdelen Bİ, Poyrazoğlu HG, et al. Assessment of psychopathology and quality of life in children and adolescents with migraine. J Child Neurol 2016;31(7):837-42.
-
42. Margari F, Lucarelli E, Craig F, et al. Psychopathology in children and adolescents with primary headaches: Categorical and dimensional approaches. Cephalalgia 2013;33(16):1311-8.
-
43. Rizvi BA, Kuziek J, Cho LY, et al. Anxiety and depressive symptoms and migraine-related outcomes in children and adolescents. Headache 2024;64(4):342-351.
-
44. Al Khalili Y, Asuncion RMD, Chopra P. Migraine headache in childhood. 2023 Mar 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.
-
45. Ziplow J. The psychiatric comorbidities of migraine in children and adolescents. Curr Pain Headache Rep 2021;11;25(11):69.
-
46. Panconesi A. Serotonin and migraine: A reconsideration of the central theory. J Headache Pain 2008;9:267-76.
-
47. Charbit AR, Akerman S, Goadsby PJ. Dopamine: What's new in migraine? Curr Opin Neurol 2010;23(3):275-81.
-
48. Pogliani L, Spiri D, Penagini F, et al. Headache in children and adolescents aged 6-18 years in northern Italy: prevalence and risk factors. Eur J Paediatr Neurol 2011;15(3):234-40.
-
49. Tarantino S, Proietti Checchi M, Papetti L, et al. Interictal cognitive performance in children and adolescents with primary headache: A narrative review. Front Neurol 2022;13:13:898626.
-
50. Langdon R, DiSabella M, Strelzik J, et al. Pediatric migraine and academics. Curr Pain Headache Rep 2020;11:24(8):40.
-
51. O'Brien HL, Slater SK. Comorbid psychological conditions in pediatric headache. Semin Pediatr Neurol 2016;23(1):68-70.
-
52. Kutuk MO, Tufan AE, Guler G et al. Migraine and associated comorbidities are three times more frequent in children with ADHD and their mothers. Brain Dev 2018;40(10):857-64.
-
53. Costa-Silva MA, Prado ACA, de Souza LC, et al. Cognitive functioning in adolescents with migraine. Dement Neuropsychol 2016;10(1):47-51.
-
54. Villa TR, Correa Moutran AR, Sobirai Diaz LA, et al. Visual attention in children with migraine: a controlled comparative study. Cephalalgia 2009;29:631-4.
-
55. Parisi P, Verrotti A, Paolino MC, et al. Headache and cognitive profile in children: A cross-sectional controlled study. J Headache Pain 2010;11(1):45-51.
-
56. Chiappedi M, Mensi M, Antonaci E, et al. Intellectual profile of adolescents with headache: A case-control study using the WISC-IV. Front Neurol 2018;9:128.
-
57. Esposito M, Pascotto A, Gallai B, et al. Can a headache impair intellectual abilities in children? An observational study. Neuropsychiatr Dis Treat 2012;8:509-13.
-
58. Ferreira KS, Teixeira CT, Cáfaro C, et al. Chronic migraine patients show cognitive impairment in an extended neuropsychological assessment. Arq Neuropsiquiatr 2018;76(9):582-7.
-
59. Münte TF, Heldmann M, Hinrichs H, et al. Contribution of subcortical structures to cognition assessed with invasive electrophysiology in humans. Front Neurosci 2008;2:72-8.
-
60. Waldie KE, Welch D. Cognitive function in tension-type headache. Curr Pain Headache Rep 2007;11(6):454-60.