Comorbidity of Psychiatric and Behavioral Disorders in Pediatric Migraine


  • Ann Pakalnis MD,

  • Jessica Gibson MS,

  • Andrew Colvin PhD

  • From the Departments of Pediatrics and Neurology, The Ohio State University, College of Medicine, Columbus, OH (Dr. Pakalnis); Department of Psychology, Columbus Children's Hospital, Columbus, OH (Ms. Gibson and Dr. Colvin); and Department of Psychology, Ohio University, Athens, OH (Ms. Gibson).

  • This study was supported in part by a research grant from the National Headache Foundation.

Address all correspondence to Dr. Ann Pakalnis, Section of Neurology, Children's Hospital, 700 Children's Drive, Columbus, OH 43205.


Objective.—To determine whether behavioral and psychiatric disorders occur more frequently in school-age children with migraine headache. To also elucidate treatment response related to comorbid psychiatric or behavioral diagnosis.

Background.—Recurrent migraine headaches are common in school-age children. Concurrent behavioral or psychiatric diagnoses could significantly impact headache frequency, severity, and response to treatment.

Methods.—Healthy children from 6 to 17 years of age presenting to our headache clinic with migraine headache according to International Headache Society (IHS) criteria were identified. Parents/guardians were asked to complete the Child Symptom Inventory, 4th edition (CSI-4) after written informed consent. Children with positive rating scales underwent psychological interviews for confirmatory diagnosis. Results were compared to controls. Headache patients were assigned our usual treatment paradigm. Response regarding headache frequency was assessed at 3 months.

Results.—A total of 47 patients were diagnosed with migraine headaches. The mean age was 10.55 years. Thirty controls were identified. After completing the CSI-4 and confirmatory psychological interview, 14 of 47 headache patients fulfilled Diagnostic and Statistical Manual (DSM-4) criteria for a psychiatric or behavioral disorder. Oppositional defiant disorder (ODD) was significantly represented among children with migraine compared to the control group of children. Headache patients improved significantly post-treatment regarding their headache frequencies regardless of comorbid psychiatric or behavioral disorder. No significant differences were noted between boys and girls regarding diagnoses or treatment outcome.

Conclusion.—ODD was a significant comorbidity in our headache population. Although families complained of significant behavioral symptomatology in their children, most of these symptoms did not qualify their children for a psychiatric diagnosis and may be related to the stressors of headache on social/school disruption.