Subscribe to RSS
DOI: 10.1055/a-2595-0501
Difficulties in Emotion Regulation and Psychiatric Symptoms in Adolescents Diagnosed with Migraine: A Case-Control Study
Funding None.

Abstract
Introduction
This study aims to evaluate difficulties in emotion regulation and accompanying psychiatric symptoms in adolescents diagnosed with migraine.
Methods
The study included 30 adolescents aged 12 to 18 years diagnosed with migraine and 30 age- and sex-matched healthy controls. Participants were assessed using the Difficulties in Emotion Regulation Scale (DERS-16), the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA), and the Revised Child Anxiety and Depression Scale (RCADS). Additionally, parents completed the Strengths and Difficulties Questionnaire (SDQ).
Results
Adolescents with migraine showed significantly greater difficulties in emotion regulation (DERS-16 total score, t = 3.521, p = 0.026, effect size = 0.64) and higher levels of depression, generalized anxiety and social anxiety (RCADS score t = 4.328, effect size = 1.32, p < 0.01; t = 2.354, effect size = 0.59, p = 0.022; t = 3.363, effect size = 1.12, p < 0.01, respectively) compared to controls. Parental assessments indicated higher internalizing and total difficulty scores in the migraine group (SDQ score z = 2.633, effect size = 048, p = 0.008; t = 2.419, effect size = 032, p = 0.016; t = 2.095, effect size = 029, p = 0.036, respectively). However, there were no significant group differences in the use of emotion regulation strategies (ERQ-CA score t = −0.236, p = 0.814; t = −0.957, p = 0.104, respectively).
Conclusion
This study highlights the psychological and emotional difficulties experienced by adolescents with migraine, emphasizing the importance of early psychiatric evaluation and psychotherapeutic interventions aimed at improving emotion regulation skills and psychosocial interventions focusing on lifestyle modifications as part of comprehensive migraine management. Limitations include the cross-sectional design, reliance on self-report measures, and modest sample size, which may limit generalizability. Future longitudinal and neurobiologically informed research is needed to clarify causal relationships and intervention targets.
Authors' Contributions
The study was planned by G.Y.T., S.S., G.T., and A.Ç. G.Y.T., S.S., A.H.S., and S.A. collected data. G.Y.T., G.T., and S.A. contributed to the analysis and interpretation of the data drafted the article, and revised it. All authors read and approved the final manuscript.
The study was performed in compliance with ethical standards by the ethics committee of the Health Sciences University Erzurum Regional Training and Research Hospital (2022/06-52).
Publication History
Received: 03 March 2025
Accepted: 24 April 2025
Accepted Manuscript online:
28 April 2025
Article published online:
08 May 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
References
- 1 Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol 2010; 52 (12) 1088-1097
- 2 Youssef PE, Mack KJ. Episodic and chronic migraine in children. Dev Med Child Neurol 2020; 62 (01) 34-41
- 3 Poyrazoğlu HG, Kumandas S, Canpolat M. et al. The prevalence of migraine and tension-type headache among schoolchildren in Kayseri, Turkey: an evaluation of sensitivity and specificity using multivariate analysis. J Child Neurol 2015; 30 (07) 889-895
- 4 Olesen J. International classification of headache disorders. Lancet Neurol 2018; 17 (05) 396-397
- 5 Calkins SD, Perry NB. The development of emotion regulation: Implications for child adjustment. https://doi.org/10.1002/9781119125556.devpsy306
- 6 Crowell JA. Development of emotion regulation in typically developing children. Child Adolesc Psychiatr Clin N Am 2021; 30 (03) 467-474
- 7 Miscioscia M, Di Riso D, Spaggiari S. et al. Emotional experience and regulation in juvenile primary headaches: a cross-sectional pilot study. Children (Basel) 2022; 9 (11) 1630
- 8 Duan S, Ren Z, Xia H. et al. Associations between anxiety, depression with migraine, and migraine-related burdens. Front Neurol 2023; 14: 1090878
- 9 Duan J, Yang R, Lu W, Zhao L, Hu S, Hu C. Comorbid bipolar disorder and migraine: from mechanisms to treatment. Front Psychiatry 2021; 11: 560138
- 10 Minen MT, Begasse De Dhaem O, Kroon Van Diest A. et al. Migraine and its psychiatric comorbidities. J Neurol Neurosurg Psychiatry 2016; 87 (07) 741-749
- 11 Sic A, Bogicevic M, Brezic N, Nemr C, Knezevic NN. Chronic stress and headaches: the role of the HPA axis and autonomic nervous system. Biomedicines 2025; 13 (02) 463
- 12 Kursun O, Yemisci M, van den Maagdenberg AMJM, Karatas H. Migraine and neuroinflammation: the inflammasome perspective. J Headache Pain 2021; 22 (01) 55
- 13 Puledda F, Silva EM, Suwanlaong K, Goadsby PJ. Migraine: from pathophysiology to treatment. J Neurol 2023; 270 (07) 3654-3666
- 14 Gerstl L, Tadych N, Heinen F. et al. Migraine and the development of additional psychiatric and pain disorders in the transition from adolescence to adulthood. Cephalalgia 2021; 41 (13) 1342-1347
- 15 Sangermani R, Boncimino A. Adolescent migraine: diagnostic and therapeutic approaches. Neurol Sci 2015; 36 (Suppl. 01) 89-92
- 16 Szperka C. Headache in children and adolescents. Continuum (Minneap Minn) 2021; 27 (03) 703-731
- 17 Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 1997; 38 (05) 581-586
- 18 Güvenir T, Özbek A, Baykara B, Arkar H, Şentürk B, İncekaş S. Güçler ve güçlükler anketi'nin (gga) Türkçe uyarlamasinin psikometrik özellikleri. Turkish Journal of Child and Adolescent Mental Health 2008; 15 (02) 65-74
- 19 Gormez V, Kılınçaslan A, Orengul AC. et al. Psychometric properties of the Turkish version of the Revised Child Anxiety and Depression Scale–Child Version in a clinical sample. Psychiatry Clin Psychopharmacol 2017; 27 (01) 84-92
- 20 Bjureberg J, Ljótsson B, Tull MT. et al. Development and validation of a brief version of the difficulties in emotion regulation scale: the DERS-16. J Psychopathol Behav Assess 2016; 38 (02) 284-296
- 21 Yiğit İ, Guzey Yiğit M. Psychometric properties of Turkish version of difficulties in emotion regulation scale-brief form (DERS-16). Curr Psychol 2019; 38: 1503-1511
- 22 Gullone E, Taffe J. The emotion regulation questionnaire for children and adolescents (ERQ–CA): a psychometric evaluation. Psychol Assess 2012; 24 (02) 409-417
- 23 Tetik S, Önder FC. Çocuk Ve Ergenlerde Duygu Düzenleme Ölçeğinin Türkçeye Uyarlanmasi. Çukurova Üniversitesi Sosyal Bilimler Enstitüsü Dergisi 2021; 30 (02) 87-100
- 24 Yilmaz Kafali H, Atik Altinok Y, Ozbaran B. et al. Exploring emotional dysregulation characteristics and comorbid psychiatric disorders in type 1 diabetic children with disordered eating behavior risk. J Psychosom Res 2020; 131: 109960
- 25 Maleki N, Becerra L, Borsook D. Migraine: maladaptive brain responses to stress. Headache 2012; 52 (Suppl. 02) 102-106
- 26 Borsook D, Maleki N, Becerra L, McEwen B. Understanding migraine through the lens of maladaptive stress responses: a model disease of allostatic load. Neuron 2012; 73 (02) 219-234
- 27 Gazerani P. Migraine and mood in children. Behav Sci (Basel) 2021; 11 (04) 52
- 28 Powers SW, Gilman DK, Hershey AD. Headache and psychological functioning in children and adolescents. Headache 2006; 46 (09) 1404-1415
- 29 Cuvellier J-C. Pediatric vs. adult prodrome and postdrome: a window on migraine pathophysiology?. Front Neurol 2019; 10: 199
- 30 Blaauw BA, 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
- 31 Orr SL, Potter BK, Ma J, Colman I. Migraine and mental health in a population-based sample of adolescents. Can J Neurol Sci 2017; 44 (01) 44-50
- 32 Akça ÖF, Özkan M, Teber ST. Migren ve gerilim tipi baş ağrısı olan ergenlerde anksiyete duyarlılığı ve dissosiyatif belirtiler. Anatol J Psych 2013; 14 (02) 161-166
- 33 Pesa J, Lage MJ. The medical costs of migraine and comorbid anxiety and depression. Headache 2004; 44 (06) 562-570
- 34 Operto FF, Scuoppo C, Padovano C. et al. Migraine and epilepsy: social cognition skills in pediatric population. Eur J Paediatr Neurol 2022; 37: 68-74
- 35 Natalucci G, Faedda N, Quinzi A. et al. Alexithymia, metacognition, and theory of mind in children and preadolescents with migraine without aura (MWoA): a case-control study. Front Neurol 2019; 10: 774
- 36 Romero-Godoy R, Romero-Godoy SR, Romero-Acebal M, Gutiérrez-Bedmar M. Psychiatric comorbidity and emotional dysregulation in chronic tension-type headache: a case-control study. J Clin Med 2022; 11 (17) 5090
- 37 Wolf J, Danno D, Takeshima T, Vancleef LM, Yoshikawa H, Gaul C. The relation between emotion regulation and migraine: a cross-cultural study on the moderating effect of culture. Cephalalgia 2020; 40 (04) 384-392
- 38 Faedda N, Natalucci G, Calderoni D, Cerutti R, Verdecchia P, Guidetti V. Metacognition and headache: which is the role in childhood and adolescence?. Front Neurol 2017; 8: 650
- 39 Natalucci G, Faedda N, Quinzi A. et al. Metacognition and theory of mind in children with migraine and children with internalizing disorders. Neurol Sci 2019; 40 (Suppl. 01) 187-189
- 40 Sheftall AH, Vakil F, Armstrong SE. et al. Clinical risk factors, emotional reactivity/regulation and suicidal ideation in elementary school-aged children. J Psychiatr Res 2021; 138: 360-365
- 41 Fu W, Zhang W, Dong Y, Chen G. Parental control and adolescent social anxiety: A focus on emotional regulation strategies and socioeconomic influences in China. Br J Dev Psychol 2025; 43 (01) 82-97
- 42 Bourgeais-Rambur L, Beynac L, Villanueva L. [Brain network dysfunctions as substrates of primary headaches]. Biol Aujourdhui 2019; 213 (1–2): 43-49
- 43 Noseda R, Kainz V, Borsook D, Burstein R. Neurochemical pathways that converge on thalamic trigeminovascular neurons: potential substrate for modulation of migraine by sleep, food intake, stress and anxiety. PLoS One 2014; 9 (08) e103929
- 44 Kim DJ, Jassar H, Lim M, Nascimento TD, DaSilva AF. Dopaminergic regulation of reward system connectivity underpins pain and emotional suffering in migraine. J Pain Res 2021; 14: 631-643
- 45 Nahman-Averbuch H, Schneider II VJ, Chamberlin LA. et al. Alterations in brain function after cognitive behavioral therapy for migraine in children and adolescents. Headache 2020; 60 (06) 1165-1182