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A meta-analysis of psychological factors in children with migraine and tension-type headache


Headache affects many children and adolescent causing disability. Many studies underline the role of psychological factors in children’s headache. A recent review [1] questioned the existence of psychological difficulties in migraine children, concluding that they don’t exhibit neither more psychological dysfunctions nor more psychiatric comorbidity then healthy controls. It is not clear how psychological factors effect on different kinds of headache. We wanted to clarify if there is a difference in the influence of psychological factors on migraine compared to healthy subjects and tension-type headache (TTH).


We selected 10 studies that were comparable, had a control group, a sufficient sample size, sufficient data reporting and that used CBCL as a psycho-diagnostic tool. Internalizing and Externalizing disorders in different sub-types of headache and in healthy subjects were studied. Data were analyzed using Comprehensive Meta-Analysis Software version 2. The Hedges’g was adopted as a measure of effect size. We compared migraine patients vs controls, non-migraine patients vs controls and migraine vs TTH in 3 meta-analysis using Externalizing/Internalizing scales scores as a categorical moderator factor.


Both migraine and TTH patients showed more psychopathology than healthy controls (respectively p <,001; p=0.0002). Both the sub-types showed more marked difference with the healthy controls at the Internalizing than at the Externalizing scale (TTH respectively p=0.009, 0=0.051). There was no significant difference between the two sub-types (migraine, TTH).


Psychological factors influence headache in children, both migraine and TTH. We suggest to investigate this area and to treat children and adolescent in order to prevent a chronic evolution of the pain syndrome. CBCL may be a useful tool for a psychological evaluation.


  1. Bruijn J, Locher H, Passchier J, et al.: Psychopathology in children and adolescents with migraine in clinical studies: a systematic review. Pediatrics 2010, 126: 323–332. 10.1542/peds.2009-3293

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Open Access This article is distributed under the terms of the Creative Commons Attribution 2.0 International License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Balottin, U., Poli, P.F., Termine, C. et al. A meta-analysis of psychological factors in children with migraine and tension-type headache. J Headache Pain 14 (Suppl 1), P20 (2013).

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