Details
Category: Volume 06 Issue 05 May 2018
Hits: 1131

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.

References

  1. Ahmed F. Headache disorders: differentiating and managing the common subtypes. British Journal of Pain. 2012;6(3):124-132. 
  2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808.
  3. Song T-J, Cho S-J, Kim W-J, Yang KI, Yun C-H, Chu MK. Anxiety and Depression in Tension-Type Headache: A Population-Based Study. Fuh J-L, ed. PLoS ONE. 2016;11(10):e0165316.
  4. Kristoffersen ES, Lundqvist C, Aaseth K, Grande RB, Russell MB. Management of secondary chronic headache in the general population: the Akershus study of chronic headache. The Journal of Headache and Pain. 2013;14(1):5. 
  5. Maizels M. The clinician’s approach to the management of headache. Western Journal of Medicine. 1998;168(3):203-212.
  6. Friedman BW, Grosberg BM. Diagnosis and management of the primary headache disorders in the emergency department setting. Emergency medicine clinics of North America. 2009;27(1):71-viii. 
  7. Cavallini A, Micieli G, Bussone G, Rossi F, Nappi G. Headache and quality of life. Headache. 1995 Jan;35(1):29-35.
  8. Erratum in: Headache 1995 Jun;35(6):314. Guidetti V, Galli F, Fabrizi P, Giannantoni AS, Napoli L, Bruni O, Trillo S. Headache and psychiatric comorbidity: clinical aspects and outcome in an 8-year,follow-up study. Cephalalgia. 1998 Sep;18(7): 455-62.
  9. Torelli P, Lambru G, Manzoni GC. Psychiatric comorbidity and headache: clinical and therapeutical aspects. Neurol Sci. 2006 May;27 Suppl 2:S73-6.
  10. Desai SD, Pandya RH. Study of psychiatric comorbidity in patients with headache using a short structured clinical interview in a rural neurology clinic in Western India. Journal of Neurosciences in Rural Practice. 2014;5(Suppl 1):S39-S42. 
  11. Breslau N, Davis GC. Migraine, physical health and psychiatric,disorder: A prospective epidemiologic study in young adults. J Psychiatr Res 1993;27:211
  12. Merikangas KR, Angst J, Isler H. Migraine and psychopathology: Results of Zurich cohort study of young adults. Arsch Gen Psychiatry 1990;47:849–53.
  13. Alvin E, Lake III, Jeanetta CR, et al. Headache and psychiatric comorbidity: Historical context, clinical implications and research relevance. Headache: The Journal of Head and Face Pain 2005; 45:493–506.
  14. Radat F, Swendsen J. Psychiatric comorbidity in migraine: A review. Cephalalgia 2005;25:165–78.
  15. Wacogne C, Lacoste JP, Guillibert E, et al. Stress, anxiety, depression and migraine. Cephalalgia 2003;23:451–5.
  16. Chaturvedi SK, Micheal A, Sarmakadam S. Somatization and psychiatric care. Indian J Psychiatry 1987;29:337–42.
  17. Lloyd GA. Psychiatric syndrome with somatic presentation. J Psychosom Res 1986;113–20.
  18. Patel V. Cultural factors and international epidemiology. Br Med Bull 2001;57:33–45.
  19. Merikangas KR, Stevens DE. Comorbidity of migraine and psychiatric disorders. Neurol Clin. 1997 Feb;15(1):115-23.
  20. Mitsikostas DD, Thomas AM. Comorbidity of headache and depressive disorders. Cephalalgia  1999;19:211.

Corresponding Author

Dr K.V. Prabhu

Resident, Department of Psychiatry,

Govt. Thanjavur Medical College, Thanjavur