Executive Functions, Anxiety, Social Participation and Quality of Life in Children with Migraine During COVID-19

Abstract

Abstract Objective: To compare executive functions (EF), anxiety, social participation, and quality of life (QoL) between children with migraine and healthy controls during the COVID-19 pandemic, and to examine these parameters in children in each group who did vs. did not contract COVID-19. Background: Migraine is among the most prevalent headache disorders in children, especially in adolescents. Migraine is exacerbated by stress, and it holds potential to affect patients’ emotional and cognitive state and, by extension, their functioning and wellbeing – parameters that were also affected by the COVID-19 pandemic. Materials and Methods: A prospective cohort study. The patient group comprised children seen in our pediatric neurology clinic for migraine, and the control group was composed of aged-matched healthy children with no neurological findings or developmental disorders. Participants’ parents completed a health and demographic questionnaire, BRIEF (child/adolescent version), PedsQL, the State-Trait Anxiety Inventory for Children (STAIC) and CASP. Participants or their parents furnished information on whether the participant had contracted COVID-19. Results: 84 children and adolescents aged 6–17.5 participated in the study: 33 with migraine (17 boys, 16 girls); 51 healthy controls (28 boys, 23 girls). Children with migraine showed significantly lower EF due to reduced behavioral regulation, higher trait anxiety, and lower physical, emotional, and school related QoL. Reduced EFs correlated with intensity of migraine attacks, higher anxiety, reduced social participation, and reduced QoL. Lower social participation correlated with reduced QoL and predicted emotional and social QoL. The BRIEF metacognition scale predicted school-related QoL. Healthy children who contracted COVID-19 showed significantly lower EF than children with migraine in the inhibition (56.66±10.56 vs 45.71±7.12-, p=.013) and initiation (60.01±11.89 vs 46.01±6.54, p=.005) BRIEF scales, and in the general metacognition index (65.83±14.48 vs 46.75±9.19, p=.003). Healthy children who contracted COVID-19 had significantly worse initiation and working memory compared to those who did not contract COVID-19 (initiation: 60.01±11.89 vs 46.81±8.89, p=.007), working memory: 61.16±15.48 vs 47.21±11.06, p=.021). Conclusion: Migraine has a significant negative impact on executive functions in children and adolescents, even more than contracting COVID-19. Executive dysfunction influences their emotional state, participation in social activities, and quality of life. The COVID-19 pandemic had a less deleterious effect on migraine patients compared to the healthy control group. Further research on pediatric migraine is warranted.