Title: Psychiatric Co-Morbidities in Patients Presenting with Headache: A Prospective Study
Authors: Dr K. Balamurali, Dr K.V. Prabhu, Dr M. Thangaraj, Dr I. Meenakshi, Dr M. Arun Kumar
DOI: https://dx.doi.org/10.18535/jmscr/v6i5.100
Abstract
Background: Psychiatric disorders are commonly encountered in patients attending neurology OPD and headache is one of the most common complaints addressed by primary care physicians and neurologists. These psychiatric co-morbidities are likely to be missed if proper evaluation of these patients is not done. Psychiatric co-morbidities worsen the headache and there is a vicious cycle of headache and psychiatric symptoms aggravating each other. It is of utmost importance that an early psychiatric consultation is sought so that this vicious cycle can be broken. This study is conducted to find out the prevalence of psychiatric co-morbidity among patients attending neurology OPD for various types of headache.
Aims and Objectives: To study the prevalence of psychiatric co-morbidity in various types of headaches in the outpatient Department of Neurology in a tertiary care hospital.
Materials and Methods: This was a prospective cohort study in which all the Patients presenting with primary complaints of headache were included on the basis of a predefined inclusion and exclusion criteria. The type of headache was diagnosed by a Neurologist. Basic investigations like complete blood count, Blood sugar level, estimation of resting blood pressure was done in all patients. These basic investigations were followed by CT Brain and EEG. All patients underwent psychiatric consultation to confirm or rule out Presence of psychiatric co-morbidities and to undergo the necessary psychological evaluation for the diagnosis. The data was tabulated and statistical analysis was done using SPSS 16.0 version software
Results: Out of the 60 subjects with primary complaints of headache there were 21 (35%) males and 39 (65%) females with a M:F ratio of 1:1.85. Out of the studied cases 47 patients (78.33%) had some or the other form of psychiatric co-morbidity. Most common psychiatric co-morbidity was found to be depression which was seen in 18 patients (38.3%) followed by somatoform disorder (31.9%), dysthymia (6.38%), panic disorder (10.63%), psychogenic non epileptic seizures (8.51%) and substance dependence (4.25%). Out of the 60 subjects, 27 patients had Migraine (45%), 24 patients had Tension type of headache (40%), 4 patients had Trigeminal Neuralgia (6.67%), 2 patients had Cluster headache (3.33%), and 3 patients with headache not classifiable (5%). Patients with age less than 35 years most commonly had migraine and with age more than 35 years had depression and somatoform disorder, and most of them were females in both groups.
Conclusion: Psychiatric disorders are a significant comorbidity among patients presenting with headache. It is important to identify presence of such co-morbidity so that a timely psychiatric consultation is sought. Such a psychiatric consultation and further psychiatric treatment, if required, is crucial in these patients.
Keywords: Headache, Psychiatric co-morbidity, vicious cycle, management.
