Einflüsse auf die Stressbelastung bei jugendlichen Mädchen mit chronischen Kopfschmerzen

Zusammenfassung

Chronische Kopfschmerzen bei Kindern und Jugendlichen sind ein häufiges Krankheitsbild, bei dem Stressfaktoren eine bedeutsame Rolle spielen. Aus der empirischen Literatur ergibt sich, dass die Stressbelastung bei Jugendlichen erhöht ist, sie aber gleichzeitig nur über sehr eingeschränkte Fertigkeiten zur Bewältigung von Stresssituationen verfügen. In der vorliegenden Arbeit wurde in einer kontrollierten Querschnittsstudie überprüft, welche Unterschiede sich beim Vergleich von Mädchen mit chronischen Kopfschmerzen mit einer Kontrollgruppe bezüglich Stressbelastung und Stressbewältigung zeigen. Mit multiplen linearen Regressionsanalysen wurde geprüft, welche Variablen die Stressbelastung auf körperlicher und psychischer Ebene beeinflussen. Es wurden insgesamt 148 Mädchen untersucht im Altersbereich von 13–17 Jahren. Stressbelastung und Stressbewältigung wurden mit dem Fragebogen zur Erhebung von Stress und Stressbewältigung im Kindes- und Jugendalter (SSKJ 3–8) gemessen. Speichelproben zur Bestimmung von Kortisol wurden zu Hause nach dem Aufwachen gesammelt. Die Ergebnisse belegen eine höhere Stressbelastung der Mädchen mit Kopfschmerzen auf körperlicher und psychischer Ebene und eine größere Empfindlichkeit für die Wahrnehmung einer Situation als stressbezogen. Die Stressbewältigungsstrategien waren signifikant ungünstiger. Spezifisch für die Mädchen mit Kopfschmerzen fand sich eine erhöhte Kortisolsekretion nach dem Aufwachen. 25 % des Stresserlebens auf körperlicher Ebene (z. B. Schwindelgefühle, Magenbeschwerden, Muskelverspannungen) konnten statistisch erklärt werden, wobei ängstliche Kinder die körperlichen Beschwerden deutlicher erlebten. 47 % des Stresserlebens auf psychischer Ebene (z. B. Unruhe, Besorgnis, Hilflosigkeit) konnten statistisch erklärt werden, wobei ängstliche Kinder und jene mit häufigen Stimmungsschwankungen diese Beeinträchtigungen deutlicher erlebten.

Abstract

Chronic headache in adolescents is frequent, and stress may play an important role. The empirical literature suggests that stress load of headache sufferers is increased, but stress coping is limited. The present study investigated in a controlled design on a cross-sectional basis the differences between girls with chronic headache and controls with regard to stress load and stress coping. Furthermore, psychopathological characteristics such as anxiety and depression were measured and a biological indicator for chronic stress (the cortisol awakening response) was obtained. Multiple linear regression was used to identify variables that have an influence on physical and psychological stress load. 148 girls were investigated. Stress load and stress coping was measured by the Questionnaire for the Measurement Stress and Coping in Children and Adolescents (SSKJ 3–8). Saliva samples were collected at home after awakening. Girls with headache had a higher stress load and a higher stress vulnerability, but significant deficits in stress coping. The cortisol awakening response was increased specifically for girls with headache. The results show a higher physiological as well as psychological stress load for the girls with headache and a higher stress vulnerability. Coping strategies were more inadequate. Physiological stress load could be mainly predicted by anxiety symptoms. Psychological stress load was influenced by anxiety and depression and furthermore by destructive stress coping.

Schlüsselwörter

Kopfschmerz - jugendliche Mädchen - Stress - Stressbewältigung - Angst - Depression

Key words

Headache - Adolescent Girls - Stress - Stress Coping - Anxiety - Depression

Publication History

Article published online:
05 June 2025

• Literatur

• 1 Abu-Arafeh I, Razak S, Sivaraman B. et al. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol 2010; 52: 1088-1097
• 2 Kröner-Herwig B, Morris L, Heinrich M. et al. Agreement of parents and children on characteristics of pediatric headache, other pains, somatic symptoms, and depressive symptoms in an epidemiologic study. Clin J Pain 2009; 25: 58-64
• 3 Foiadelli T, Piccorossi A, Sacchi L. et al. Clinical characteristics of headache in Italian adolescents aged 11–16 years: a cross-sectional questionnaire school-based study. Ital J Pediatr 2018; 44: 44
• 4 Waldie KE. Childhood headache, stress in adolescence, and primary headaches in young adulthood: a longitudinal cohort study. Headache 2001; 41: 1-10
• 5 Moon H-J, Seo J-G, Park S-P. Perceived stress in patients with migraine: a case-control study. J Headache Pain 2017; 18: 73
• 6 Zouini B, Sfendla A, Senhaji M. et al. Somatic health and its association with negative psychosocial factors in a sample of Moroccan adolescents. SAGE Open Med 2019; 7: 2050312119852527
• 7 Rousseau-Salvador C, Amouroux R, Annequin D. et al. Anxiety, depression and school absenteeism in youth with chronic or episodic headache. Pain Res Manag 2014; 19: 235-240
• 8 Connelly M, Dilts J, Boorigie M. et al. A prospective evaluation of the effects of the COVID-19 pandemic on youth with primary headache disorders. Children (Basel) 2023; 10: 184
• 9 Bernstorff M, Rask CU, Rytter D. et al. Multiple health complaints in preadolescence and hospital contacts during adolescence: a prospective cohort study. Sci Rep 2022; 12: 7412
• 10 Hartberg S, Clench-Aas J, Kjærsti Raanaas R. et al. Coping strategies among adolescents with chronic headache and mental health problems: a cross-sectional population-based study. Springerplus 2015; 4: 801
• 11 Carasco M, Kröner-Herwig B. Psychological predictors of headache remission in children and adolescents. Adolesc Health Med Ther 2016; 7: 59-66
• 12 Blaauw B, Dyb G, Hagen K. et al. The relationship of anxiety, depression and behavioral problems with recurrent headache in late adolescence – a Young-HUNT follow-up study. J Headache Pain 2015; 16: 10
• 13 Buse DC, Reed ML, Fanning KM. et al. Comorbid and co-occurring conditions in migraine and associated risk of increasing headache pain intensity and headache frequency: results of the migraine in America symptoms and treatment (MAST) study. J Headache Pain 2020; 21: 23
• 14 Williams R, Leone L, Faedda N. et al. The role of attachment insecurity in the emergence of anxiety symptoms in children and adolescents with migraine: an empirical study. J Headache Pain 2017; 18: 62
• 15 Long R, Walker A, Pan SC. et al. Baseline factors associated with pain intensity, pain catastrophizing, and pain interference in intensive interdisciplinary pain treatment for youth. Children (Basel) 2023; 10: 1229
• 16 Orr SL, Turner A, Kabbouche MA. et al. Predictors of short-term prognosis while in pediatric headache care: an observational study. Headache 2019; 59: 543-555
• 17 Nelson S, Borsook D, Bosquet Enlow M. Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation. Pain Rep 2021; 6: e953
• 18 Rivas-Martínez I, Ambite-Quesada S, Fernández-de-las-Peñas C. et al. Salivary cortisol and melatonin levels in children with frequent episodic tension-type headache do not differ from healthy children. Acta Paediatr 2011; 100: e198-e202
• 19 Koenig J, Rinnewitz L, Warth M. et al. Psychobiological response to pain in female adolescents with nonsuicidal self-injury. J Psychiatry Neurosci 2017; 42: 189-199
• 20 Lohaus A, Eschenbeck H, Kohlmann C-W. et al. Fragebogen zur Erhebung von Stress und Stressbewältigung im Kindes- und Jugendalter. Göttingen Hogrefe 2006;
• 21 Stiensmeier-Pelster J, Schürmann M, Duda K. et al. Depressionsinventar für Kinder und Jugendliche (DIKJ). Göttingen: Hogrefe; 2009 2.
• 22 Unnewehr S. Deutsche Übersetzung des State-Trait Anxiety Inventory for Children. Unveröffentlichtes Manuskript Copyright/Bezugsadresse: Dr. Suzan Unnewehr (Berlin). 1992
• 23 Massey E, Garnefski N, Gebhardt WA. et al. Daily frustration, cognitive coping and coping efficacy in adolescent headache: a daily diary study. Headache 2009; 49: 1198-1205
• 24 Sobe H, Richter M, Berner R. et al. Functional improvement in children and adolescents with primary headache after an interdisciplinary multimodal therapy program: the DreKiP study. J Headache Pain 2022; 23: 109
• 25 Guo L, Liang L. et al. Physical activity as a causal variable for adolescent resilience levels: A cross-lagged analysis. Front Psychol 2023; 14: 1095999
• 26 Carpino E, Segal S, Logan D. et al. The interplay of pain-related self-efficacy and fear on functional outcomes among youth with headache. J Pain 2014; 15: 527-534
• 27 Li W, Guo Y, Lai W. et al. Reciprocal relationships between self-esteem, coping styles and anxiety symptoms among adolescents: between-person and within-person effects. Child Adolesc Psychiatry Ment Health 2023; 17: 21
• 28 Freire C, Del Mar Ferradás M, Regueiro B. et al. Coping strategies and self-efficacy in university students: a person-centered approach. Front Psychol 2020; 11: 841
• 29 Mikkelsen H, Haraldstad K, Helseth S. et al. Pain and health-related quality of life in adolescents and the mediating role of self-esteem and self-efficacy: a cross-sectional study including adolescents and parents. BMC Psychol 2021; 9: 128
• 30 Tornoe B, Andersen LL, Skotte JH. et al. Specific strength training compared with interdisciplinary counseling for girls with tension-type headache: a randomized controlled trial. J Pain Res 2016; 9: 257-270
• 31 Wu Y, Yu W, Wu X. et al. Psychological resilience and positive coping styles among Chinese undergraduate students: a cross-sectional study. BMC Psychol 2020; 8: 79
• 32 Mangerud W, Bjerkeset O, Lydersen S. et al. Chronic pain and pain-related disability across psychiatric disorders in a clinical adolescent sample. BMC Psychiatry 2013; 13: 272
• 33 Östberg V, Låftman SB, Modin B. et al. Bullying as a stressor in mid-adolescent girls and boys-associations with perceived stress, recurrent pain, and salivary cortisol. Int J Environ Res Public Health 2018; 15: 364