Psychiatric comorbidities in patients with headaches
Section snippets
Migraine
Several clinic-based studies utilizing the original diagnostic criteria of the International Headache Society1 and well-validated psychiatric assessments have reported increased rates of depression and anxiety in individuals with migraine.2, 3, 4, 5, 6 Although clinic-based studies can be influenced by selection bias (eg, distressed patients more likely to seek treatment), the association between psychiatric disorders and migraine reported in clinic-based studies also has been observed in
Tension-type headache
Population-based studies of headache and psychiatric comorbidity have infrequently focused on tension-type headache. The prevalence of mood and anxiety disorders does not appear to be elevated in episodic (headaches occurring <15 days per month) tension-type headache.9 However, this finding cannot be generalized to chronic tension-type headache (CTTH; headaches occurring ≥15 days monthly, as defined by the Headache Classification Subcommittee of the International Headache Society, International
Chronic daily headache
Chronic daily headache (CDH) refers to a heterogeneous group of headaches characterized as daily or near-daily headache with primarily migrainous features (chronic migraine; headaches occurring ≥15 days monthly in the absence of medication overuse, as defined by the IHCD220) or primarily tension-type features (chronic tension-type headache). Psychiatric comorbidity has been reported in 40% to 90% of patients with primary CDH in clinical samples.5, 6, 21 The most frequent diagnoses are comorbid
Comorbid psychiatric disorders and headache prognosis
Clinical wisdom suggests that psychiatric comorbidity would predict a poorer headache prognosis, although this has rarely been investigated. A recent longitudinal study suggests that the presence of psychiatric disorders (especially multiple psychiatric disorders) is predictive of poor outcome for headache.4 In an 8-year prospective follow-up study of 100 young headache sufferers, Guidetti and colleagues4 found that 86% of headache sufferers who had two or more comorbid psychiatric disorders in
Assessment of comorbid psychiatric disorders
The Primary Evaluation of Mental Disorders (PRIME-MD)30 is a diagnostic tool that can easily be used to assess the presence of comorbid psychiatric disorders in most medical settings. The PRIME-MD consists of a self-administered 26-item symptom checklist completed by the patient to screen for five of the most common DSM disorders: mood disorders; anxiety disorders (panic disorder, generalized anxiety disorder); eating disorders; alcohol abuse or dependence; and somatization disorders. The
Treatment of psychiatric comorbidity
In this section we focus on depression and panic disorder because they are the psychiatric disorders with the highest prevalence in patients with headache disorders. We present recommendations for pharmacologic and nonpharmacologic interventions, and suggest that combined treatment, or a multidisciplinary approach, should be considered for treating headache complicated by psychiatric comorbidity. Readers interested in additional information about managing these and other comorbid psychiatric
Behavioral medicine
Albert Schweitzer noted that “the greatest discovery of any generation is that human beings can alter their lives by altering the attitudes of their minds.” Behavioral medicine asserts that a person’s behavior influences the course of illness as well as the outcome. This does not imply guilt or blame for an illness, but rather emphasizes the role of the individual in the management of the illness. Lifestyle, or behavioral, factors that typically affect headache disorders include stress, sleep
Conclusions
Both population-based research and clinical experience have revealed a clear-cut association between the most commonly occurring headache types (migraine and tension type) and a number of psychiatric disorders (especially depression and anxiety). Whereas most headache sufferers in the general population do not experience diagnosable psychiatric disorders, a disproportionate number of patients who present for treatment do—most particularly patients who present to specialty clinics. Psychiatric
References (102)
- et al.
Migraine, psychiatric disorders, and suicide attemptsAn epidemiological study of young adults
Psychiatr Res
(1991) - et al.
Migraine and depressionAssociation and familial transmission
J Psychiatr Res
(1988) - et al.
Migraine, physical health and psychiatric disorderA prospective epidemiologic study in young adults
J Psychiatr Res
(1993) - et al.
The refractory headache patient—II. High medication consumption (analgesic rebound) headache
Behav Res Ther
(1989) - et al.
Enabling the diagnosis of occult psychiatric illness in the emergency departmentA randomized controlled trial of the computerized self-administered PRIME-MD diagnostic system
Ann Emerg Med Feb
(2001) - et al.
A meta-analysis of treatment outcome for panic disorder
Clin Psychol Rev
(1995) Migraine and tension-type headache in a general populationPrecipitating factors, female hormones, sleep pattern and relation to lifestyle
Pain
(1993)- et al.
Pharmacological vs. nonpharmacological prophylaxis of recurrent migraine headachea meta-analytic review of clinical trials
Pain
(1990) - et al.
Efficacy and cost-effectiveness of minimal therapist contact treatments for chronic headacheA review
Behav Ther
(1996) Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain
Cephalalgia
(1988)
Headache, panic disorder and depressionComorbidity or a spectrum?
Neuropsychobiology
Comorbidity of headache and depressive disorders
Cephalalgia
Headache and psychiatric comorbidityClinical aspects and outcome in an 8-year follow-up study
Cephalalgia
Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes
Headache
Psychiatric comorbidity in chronic daily headache
Cephalalgia
Migraine and psychopathologyResults of the Zurich Cohort Study of young adults
Arch Gen Psychiatry
Headache syndromes and psychiatric disordersAssociation and familial transmission
J Psychiatr Res
Migraine headaches and panic attacks
Psychosom Med
Comorbidity of migraine and panic disorder
Neurology
Headache types and panic disorderDirectionality and specificity
Neurology
Migraine and major depressionA longitudinal study
Headache
Headache and major depressionIs the association specific to migraine?
Neurology
MigraineAssociation with personality characteristics and psychopathology
Cephalalgia
Coping styles of headache sufferers
Cephalalgia
Comorbidity of migraine and major affective disorders
Neurology
The International Classification of Headache Disorders(IHCD2)
Psychosocial correlates and impact of chronic tension-type headaches
Headache
Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy
Cephalalgia
Transformed migraine
Cephalalgia
Psychiatric comorbidity is related to headache induced by chronic substance use in migraineurs
Headache
The failure of intensive self-regulatory treatment with chronic daily headacheA prospective study
Appl Psychophysiol Biofeedback
Paradoxical effects of frequent analgesic use
Adv Neurol
Drug induced refractory headacheclinical features and management
Headache
Intractable chronic daily headacheA persistent neurobehavioral disorder
Cephalalgia
Utility of a new procedure for diagnosing mental disorders in primary careThe PRIME-MD 1000 study
JAMA
An inventory for measuring depression
Arch Gen Psychiatry
Beck Depression Inventory-II Manual
Hamilton Depression Inventory: A Self-Report Version of the Hamilton Depression Rating Scale. Professional Manual
Beck Anxiety Inventory
STAI Manual for the State-Trait Anxiety Inventory (“Self-Evaluation Questionnaire”)
Psychiatric and psychologic factors in headache
Borderline personality disorder and the chronic headache patientReview and management recommendations
Headache
Headache in the abuse-prone individual
Lifetime and 12-month prevalence of DSM-III-R disorders in the United StatesResults from the National Comorbidity Survey
Arch Gen Psychiatry
The economic burden of depression in 1990
J Clin Psychiatry
Diagnostic and Statistical Manual of Mental Disorders
Practice parameterEvidence-based guideline for migraine headache (an evidence-based review)
Neurology
A comorbidity-directed algorithmic approach to the outpatient management of chronic migraine
Headache
Cited by (31)
Physical–Mental Comorbidity of Pediatric Migraine in the Philadelphia Neurodevelopmental Cohort
2019, Journal of PediatricsCitation Excerpt :Given the specificity of the association between migraine with anxiety and mood disorders, comorbid psychopathology also may influence the prognosis and progression of migraine headache. This is especially relevant, because behavioral and psychological risk factors may be implicated in the increase in severity and chronicity of headaches.38-40 Incorporation of comorbid disorders into treatment of children with migraine may facilitate modification of the trajectories of both conditions across the lifespan.
Overattachment and perceived disability in chronic migraineurs
2013, Clinical Neurology and NeurosurgeryCitation Excerpt :The World Health Organization (WHO) has ranked migraine 19th among all causes of disability worldwide (12th in women) [5]. Migraine is associated with financial costs related to medical care and lost productivity, functional impairment, reduced quality of life, and increased rates of comorbid medical and psychiatric conditions [2,6–24]. Several studies have documented an increase in comorbidity of mood and anxiety disorders in people with migraine [8,10,25–32].
Clinical Outcome of Nerve Decompression Surgery for Migraine Improves with Nerve Wrap
2021, Plastic and Reconstructive Surgery - Global Open