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

We aimed 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.

A prospective cohort study was carried out. 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. The participants' parents completed a health and demographic questionnaire, the BRIEF (child/adolescent version), the PedsQL, the State-Trait Anxiety Inventory for Children (STAIC), and the CASP. The participants or their parents furnished information on whether the participant had contracted COVID-19.

A total of 84 children and adolescents aged 6-17.5 (mean of 12.8) participated in the study, including 33 with migraine (17 boys, 16 girls) and 51 healthy controls (28 boys, 23 girls). The children with migraine showed significantly lower EF due to reduced behavioral regulation, higher trait anxiety, and lower physical, emotional, and school-related QoL. Reduced EF correlated with the 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 = 0.013) and initiation (60.01 ± 11.89 vs. 46.01 ± 6.54, p = 0.005) BRIEF scales, and in the general metacognition index (65.83 ± 14.48 vs. 46.75 ± 9.19, p = 0.003). 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 = 0.007), working memory: 61.16 ± 15.48 vs. 47.21 ± 11.06, p = 0.021).

Migraine has a significant negative impact on executive functions in children and adolescents, greater than contracting COVID-19. Executive dysfunction influences patients' 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.