Stress in paediatric migraine: a trigger factor?
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Stress in paediatric migraine: a trigger factor? Bruno Colombo 1 & Ilaria Cetta 1 & Roberta Messina 1 & Massimo Filippi 1
# Fondazione Società Italiana di Neurologia 2020
According to the pioneering contributions of the Austrianborn Hungarian scientist Hans Selye, stress is the body’s nonspecific response to a demand placed on it. It is defined as a state of threatened or perceived as threatened homeostasis. Stress is a highly subjective phenomenon and it is difficult to measure. The actual or perceived threat to a person is referred to as the “stressor”, and the reaction to the stressor is defined as the “stress response”. The stress reaction depends on the nature and the intensity of the stressor (true or perceived stressful triggers), on the socio-cultural context and on subject’s ability to evaluate and to cope with the problem. Chronic stress is defined as the prolonged imbalance between situational requirements and the individual’s coping resources. It is debatable if stress reaction is related more to quantity and intensity of individual emotional activation than to the quality of stressors. Although stress is considered to be the most common trigger in headache (both migraine and tensive headache), few studies are focused on childhood population [1–3]. Headache is characterized also in paediatric patients by a relevant impact on quality of life. Consequently, identification of migraine triggers may help in the management of this group of patients. A migraine trigger is defined as any factor that on exposure or withdrawal leads to the development of an headache in a susceptible individual. Pain in young migraineurs could be considered the external manifestation of the “alarm” reaction inducing response to triggering stress. The aims of this single-centre, clinical-based study are as follows: (1) to determine the prevalence of stress reported as a headache trigger in paediatric patients visited at the Headache Outpatients Center of San Raffaele Hospital in a 12-month
* Bruno Colombo [email protected] 1
Headache Unit, Department of Neurology, Scientific Institute San Raffaele Hospital, Vita-Salute University, Via Olgettina, 48 Milan, Italy
observational period, (2) to determine the significance of stress and the role of trigger factors for parents of paediatric patients and (3) to evaluate the influence on stress of age, gender and psychosocial variables. Through a semistructured interview, parents of 150 consecutively paediatric patients assessed for a first visit at Headache Center in 1 year (age 3–18, median 8; sex 67% female; disease duration: median 4 years; headache days monthly: 4, range 2–13; diagnosis according to IHS criteria: migraine without aura 70%, migraine with aura 12%, tensive headache 18%) were asked to provide a detailed clinical history and evaluate the importance and the significance of stress in their children’s headache, specifying the type and frequency of trigger factors on a diary. They were asked to fill it in prospectively for 3 consecutive months. Chil
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