Children’s Migraine Attacks Among Children Affected by Symptoms of Depression, Family Socioeconomic Status

The researchers believe that “self-reported symptoms of depression and family income are important factors to consider as part of the biopsychosocial model of care.”

Headache frequency and migraine-related disability among children may be affected by symptoms of depression and family income, according to results of a study published in the Journal of Clinical Psychology in Medical Settings.

This study was a secondary analysis of data collected during a clinical trial conducted at a midwestern children’s hospital between 2006 and 2012. Participants (N=135) were given amitriptyline and were randomly assigned to receive cognitive behavioral therapy (CBT) or psychoeducation about headaches.

Patients were assessed using the Child Depression Inventory (CDI), the Pediatric Quality of Life Inventory, and the Pediatric Migraine Disability Assessment (PedMIDAS), and information was collected about their demographics, headache frequency. and migraine-related disability.

Patients were mostly girls (79%), their ages ranged from 10 to 17 years, 89% were White, and 10% were Black.

Change in headache days was associated with baseline CDI (t, -2.80; 95% CI, -0.89 to -0.15; P =.01). For every 2-point increase in the CDI score, there was 1 more headache day after treatment, regardless of group assignment. CDI scores were more effectively reduced among children who were randomly assigned to receive CBT (mean reduction, 1.70; 95% CI, 0.49-2.91; P =.01).

After treatment, PedMIDAS scores were significantly reduced among children who had a family income between $30,000 and $39,999 compared with those whose family income was less than $9,999 per year (t, 2.08; 95% CI, 1.95-80.96; P =.04).

Children from families who earned $10,000 to $19,999 (t, 1.78; 95% CI, -5.18 to 97.46; P =.08) and at least $50,000 (t, 1.84; 95% CI, -2.17 to 59.76; P =.07) had a change in PedMIDAS scores that was trending toward significance.

This study had some limitations. It was underpowered, and the investigators were unable to test for the effect of treatment, gender, or ethnicity. There was also a large cohort imbalance, in which most participants were White girls.

These data indicated that among children who have migraine attacks, symptoms of depression and family socioeconomic status likely impacts the frequency of their headaches as well as their level of disability associated with migraine.


Rettig EK, Ergun G, Warfield JR, et al. Predictors of improvement in pediatric chronic migraine: results from the cognitive‑behavioral therapy and amitriptyline trial. J Clin Psychol Med Settings. Published online May 24, 2021. doi:10.1007/s10880-021-09782-4