Liam Davenport

June 24, 2016

SAN DIEGO, California — For adolescents, living with parents who have chronic migraine has a negative effect on activities of daily life and on school performance and is associated with increased rates of anxiety, a new study shows.

Compared with adolescents living with parents who have episodic migraine, those living with parents with chronic migraine were more than twice as likely to report difficulties concentrating at school and were almost twice as likely to have moderate to severe anxiety, among other problems, according to data presented at the American Headache Society 58th Annual Scientific Meeting.

Given the impact of parental chronic migraine on adolescents, Dawn C. Buse, PhD, associate professor, Department of Neurology, Albert Einstein College of Medicine of Yeshiva University and the Montefiore Medical Center, New York City, said that it would be "very helpful" to have several types of support for families.

She told Medscape Medical News, "Parents should be aware that their condition may be emotionally affecting their adolescents," adding: "Parents should talk openly with them about what they are experiencing and what to expect for their parent in terms of symptoms and treatment.

"Having open discussions is important among family members and can ease anxiety for everyone," she said. "In addition, if stress, depression, or anxiety have become overwhelming, whether for the person with migraine or for any family member, I urge them to seek professional mental health assistance."

For persons living with a chronic illness or caring for someone with a chronic illness, it is common to experience feelings of depression and anxiety, she added. "The good news is that these are treatable conditions."

To examine the impact of parental migraine on the lives of adolescents, the researchers divided participants in the Chronic Migraine Epidemiology and Outcomes Study into those with chronic migraine, defined as having 15 or more headache days per month, and those with episodic migraine, defined as having fewer than 15 headache days per month.

Parent-probands completed a questionnaire on the burden of migraine on their families. Offspring aged 13 to 21 years who had been living in the household for longer than the previous 2 months were invited to take part.

The adolescents completed validated questionnaires on depression and anxiety and were asked about the impact of parental headache on family, social and school activities, and their well- being.

A total of 1411 parent-adolescent dyads were included in the study. Of the parents, 168 (11.9%) had chronic migraine, and 1243 (88.1%) had episodic migraine.

The researchers found that adolescents living with parents with chronic migraine were significantly more likely than those living with parents with episodic migraine to miss family, social, and school activities (P < .001).

Adolescents with parents with chronic migraine reported a significantly greater impact of parental headache on all domains of well-being in comparison with those whose parents had episodic migraine (P < .001). For example, they were more likely to have difficulties concentrating at school (36.0% vs 16.0%) and were more likely to be unable to get help from their parents when needed (50.0% vs 27.0%).

The team also reports that adolescents with parents with chronic migraine had significantly higher rates of moderate to severe anxiety in comparison with those whose parents had episodic migraine (11.3% vs 6.2%; P < .001). There were no significant differences in rates of depression between the two groups of adolescents.

Calm and Reassure

Dr Buse explained that parents can do several things to help calm and reassure their children. These include modeling calm, coping behavior and discussing the migraines calmly and clearly, because children often take cues from parents as to how to react to a situation.

Children should also be given age-appropriate information, ideally before an attack or between attacks, when the parent is best able to communicate. Consistent household routines should be maintained as much as possible, and children should be given age-appropriate tasks they can perform during an attack.

Parents should ask for and accept help from others, including family, friends, and other parents. Dr Buse pointed out that their research shows that fewer than 50% of people with migraine have their conditions diagnosed and treated. "The first step would be for the person with migraine to get diagnosed and treated by a healthcare professional."

She said: "There are a range of safe and effective treatments available. I recommend a two-pronged approach: one is to manage the migraine itself head-on; and secondly, provide support for all family members who may be affected."

J. D. Bartleso Jr, MD, associate professor of neurology at the Mayo Clinic, Rochester, Minnesota, who was not involved in the study, said the study "confirms what seems obvious," that the more a parent is disabled by migraine, "the more likely it is to affect you as a young person growing up in their house."

He added that the findings suggest that mental health resources should be directed toward the children of parents with migraine. "If you're treating an adolescent, you should probably inquire about the family history and the health status of the parent with regard to migraine and other conditions, for that matter," he said.

Dr Bartleson noted that clinicians should "be especially ready to get help for that person, to help them cope or deal with it," adding: "It also reinforces the need to more effectively treat patients with chronic migraine in order to help their children."

He pointed out that one limitation of the study is that the researchers compared only parents with chronic and episodic migraine. "I guess you could wonder: How about the children whose parents have episodic migraine?" he said. "They're better than with chronic migraine, but maybe they would be worse off than somebody whose parents were headache-free."

The study received no funding. The investigators have disclosed no relevant financial relationships.

American Headache Society 58th Annual Scientific Meeting: Abstract 156896. Presented June 9, 2016.

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