Original articlePsychophysiological mechanisms underlying spatial attention in children with primary headache
Introduction
Headache is the most frequent neurological symptom and commonest manifestation of pain in childhood [1]. Studies have reported annual prevalence rates in children of 3–11% for migraine and 0.9–24% for tension-type headache (see [2] for a review). The negative consequences of headache in childhood and adolescence are often underestimated. Several neuropsychological studies were dedicated to the investigation of the effects of migraine on the cognitive functions especially in adult patients. Some researchers have reported that migraineurs have cognitive deficits [3], [4], [5]. The functions most often affected are memory, information speed processing, attention [5], and verbal and psychomotor ability [4]. Cognitive impairments observed in migraineurs have been found to occur during a migraine attack, after the attack, and even when the individual does not exhibit any residual effects of the attack [6]. However, there is no agreement, since other studies have found a normal cognitive performance in migraine patients [7]. Moreover, there is empirical evidence that patients with migraine, including those with aura, do not have a risk of long-term neuropsychological impairment [8].
As for the developmental age, there are only a few studies assessing the impact of migraine on neurocognitive performance and their results are often in disagreement [9], [10], [11], [12].
Somatosensory evoked potentials (SEPs) have been used to investigate the effect of spatial attention on the tactile information processing. In most studies, SEPs were recorded to electrical stimuli delivered to one hand, while the subject was asked to focus his/her attention onto the designated hand (ipsilateral or contralateral to the stimulated hand) [13], [14]. A consistent finding from these experiments is that tactile spatial attention modulates the somatosensory N140 component, with increased N140 amplitude evoked by electrical stimuli delivered to the attended hand [15]. Garcia-Larrea et al. [14] demonstrated that the N140 potential is identifiable at Cz vertex only when subject’s attention is addressed toward somatosensory stimuli delivered in the same area of the stimulated median nerve. Thus, according to this study, the N140 response is fully endogenous and requires the attentional involvement of the subject. The N140 SEP component has never been investigated in migraineurs in order to evaluate the psychophysiological mechanisms subtending spatial attention.
The present study had two main aims. First, we investigated the spatial attention in children with migraine and with tension-type headache, as compared with healthy children, using two measures: (1) the amplitude and latency modifications of the N140 SEP component during a spatial attention task, and (2) the performance in a neuropsychological test (“Deux Barrage” test) evaluating spatial attention. Second, we searched for correlations between the neurophysiological results and the scores obtained from the neuropsychological test, in order to explain the meaning of possible differences in the psychophysiological mechanisms underlying spatial attention between headache and non-headache children.
Section snippets
Participants
Thirty-eight subjects participated to the study. Sixteen patients had migraine without aura (MoA) (mean age 11.7 ± 2.7 years, 10 males, six females), 12 suffered from tension-type headache (TTH) (mean age 12.3 ± 2.8 years, eight males, four females). They were consecutively chosen from patients referred for consultation at our Headache Center. MoA and TTH patients were diagnosed according to the criteria of the International Classification of Headache Disorders, 2nd edition (ICHD-2) [16]. Clinical
Results
The experimental procedures were well tolerated by all subjects.
Mean age was similar in the groups of patients and healthy subjects (one-way ANOVA: F = 1.75, P = 0.19).
Discussion
The main results of the present study are: (1) there are not significant differences in spatial attention performance between migraineurs, TTH patients, and healthy children, (2) in migraine and TTH patients, but not in healthy children, the N140 amplitude is significantly higher during SAC than during NC, and (3) the N140 amplitude increase in SAC correlates with the neuropsychological performance in migraineurs, but not in TTH patients and healthy controls.
Although the gender ratio was
Conclusions
The behavioral data obtained in this study support the view that children suffering from headache do not have evidence of attention disturbances. However, the mechanisms underlying spatial attention in headache children are possibly different from those of non-headache children. In particular, our results may support the hypothesis that frontal connection maturation is earlier in young headache patients than in healthy children.
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