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High CSSI-24 scores in paediatric headache suggest a functional disorder and call for a neurodevelopmental
Agnese Suppiej1, Martina Ciappini1, Cristina Forest1
1S. Anna University Hospital, Paediatric Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
Insights
A subgroup of children with primary headaches exhibit functional disorders, indicated by high scores on the Children's Somatic Symptoms Inventory (CSSI-24). This finding supports a biopsychosocial approach for personalized pediatric headache treatment.
Area of Science:
- Pediatric Neurology
- Child Psychology
- Psychosomatic Medicine
Background:
- Primary headache is a common neurological symptom in children, often linked to psychosomatic factors.
- Investigating functional symptoms and anxiety is crucial for understanding pediatric headache.
- The Children's Somatic Symptoms Inventory (CSSI-24) can identify children with potential functional disorders.
Purpose of the Study:
- To investigate functional (psychosomatic) features and anxiety in children and adolescents with primary headache.
- To test the hypothesis that a subgroup with high CSSI-24 scores presents characteristics of a functional disorder.
- To explore the relationship between psychosomatic symptoms, anxiety, and headache characteristics.
Main Methods:
- A prospective observational cohort study of 148 children aged >6 years with primary headache.
- Diagnosis based on ICHD-3 criteria by child neurologists.
- Patients stratified using CSSI-24 into low (<19) and high (≥19) psychosomatic score groups.
Main Results:
- 42.6% of participants had high CSSI-24 scores (≥19).
- The high-score group included more females, older children, and reported greater pain intensity, higher headache frequency, and more chronic analgesic use.
- Significant associations found between high CSSI-24 scores, multiple psychosomatic risk factors, severe somatic symptoms, and higher anxiety levels.
Conclusions:
- Identifying a high CSSI-24 score subgroup in pediatric primary headache has implications for conceptual models.
- Supports integrating neurodevelopmental and biopsychosocial perspectives in understanding pediatric headache.
- Early recognition of a functional phenotype can guide personalized, multidisciplinary interventions for stress, anxiety, and behavior.
Background And Objectives:
Primary headache is the most frequent neurological symptom in childhood and often coexists with psychosomatic risk factors. This study investigated functional (psychosomatic) features and anxiety in children and adolescents with primary headache, testing the hypothesis that a subgroup with high Children's Somatic Symptoms Inventory (CSSI-24) scores may present characteristics consistent with a functional disorder.
Methods:
In this prospective observational cohort study, 148 patients aged >6 years with primary headache, diagnosed according to ICHD-3 criteria by child neurologists at a tertiary hospital, were enrolled. Demographic and clinical data, psychosomatic risk factors, and anxiety were collected through interviews and validated questionnaires. Patients were stratified using the CSSI-24 into Group 1 (<19: low psychosomatic score) and Group 2 (≥19: high psychosomatic score). Associations between functional symptoms , anxiety, and headache characteristics were analysed.
Results:
Overall, 42.6% of participants had CSSI-24 ≥ 19. Compared with Group 1, Group 2 included more females (p = 0.046), were older (p = 0.013), and reported greater pain intensity (p = 0.02), higher monthly headache frequency (p = 0.04), and more frequent chronic analgesic use (p = 0.012). They also showed multiple psychosomatic risk factors (p = 0.04), severe somatic symptoms across several systems (p < 0.001), and higher anxiety levels (p < 0.001).
Conclusions:
The identification of high CSSI-24 scores in a subgroup of children with primary headache could have implications for the conceptual model of pediatric headache and supports integrating neurodevelopmental and biopsychosocial perspectives. Early recognition of a "functional" phenotype may guide personalized, multidisciplinary interventions addressing stress, anxiety, and maladaptive behaviour.
