A study on prevalence and co-morbidity of bipolar and anxiety disorders in chronic headache patients
Keywords:GAD-generalized anxiety disorder, Headache, Psychiatry comorbidity, PTSD-post traumatic stress disorder, TTH- Tension type of headache
Background: Co morbidity between headache and psychiatric disorders is more prevalent in chronic headache patients. The bipolar disorders and anxiety disorders are predominant in migraine and TTH respectively. This co morbidities have a poor reflection and impact on quality and outcome of chronic headache patients and results in worst prognosis and poor response to medical treatment.
Methods: The chronic headache patients especially migraine and tension type of headache were analyzed with following materials such as the structured psychiatric clinical interview with ICD-10 mental and behavioural disorder, DSM-5 criteria. HAM-A, HAM-D, BDI-2, BPRS, young mania rating scale, Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and panic disorder scale.
Results: Various subsets of bipolar disorder and anxiety disorder were found as follows: 74% of migraineurs are associated with psychiatric disorders in which bipolar affective disorder 6%, depressive episode 48%, dysthymia 30%, GAD 10% and Panic disorder 6%. 52% of TTH are associated with psychiatric disorders as follows: major depressive episode 52%, GAD 30%, separation anxiety disorder 6%, PTSD 7%, OCD 3% and panic disorder 2%.
Conclusions: From previous and future studies the headache can be identified according to subsets of headache with psychiatric disorders make easier to provide appropriate pharmacological and psychological treatment which may reduce the chronicity and intractability of headache.
Peterlin BL, Katsnelson MJ, Calhoun AH. The Associations Between Migraine, Unipolar Psychiatric Comorbidities, and Stress-related Disorders and the Role of Estrogen. Curr Pain Headache Rep. 2009;13(5):404-12.
Fasmer OB, Oedegaard KJ. Clinical characteristics of patients with major affective disorders and comorbid migraine. World J Biol Psychiatr. 2001;2(3)149-55.
Hargreaves RJ, Shepheard SL. Pathophysiology of migraine-new insights. Can J Neurol Sci. 1999;26(3):S12-9.
Silberstein SD. Comprehensive management of headache and depression. Cephalalgia. 1998;18(21):50-5.
Breslau N, Davis GC, Schultz LR, Peterson EL. Migraine and major depression, A longitudinal study. Headache. 1994;34(10):387-93.
Merikangas KR, Angst J, Isler H. Migraine and psychopathology. Results of the Zurich cohort study of young adults. Arch Gen Psychiatr. 1990;47(9):849-53.
Juang KD, Yang CY. Psychiatric comorbidity of chronic daily headache; Focus on traumatic experiences in childhood, post-traumatic stress disorder and suicidality. Curr pain headache rep. 2014;18(4):1-7.
Singh AK, Shukla R, Trivedi JK, Singh D. Association of psychiatric co-morbidity and efficacy of treatment in chronic daily headache in Indian population. J Neurosci Rural Pract. 2013;4(2):132-9.
Antonaci F, Nappi G, Galli F, Manzoni GC, Calabresi P, Costa A. Migraine and psychiatric comorbidity; a review of clinical findings Headache Pain. 2011;12(2):115-25.
Breslau N, Lipton RB, Stewart WF, Schultz LR, Welch KM. Comorbidity of migraine and depression: investigating potential etiology and prognosis. Neurol. 2003;60(8)1308-12.
Ferrari MD, Odnik J, Tapparelli C, Van Kempen GM, Pennings EJ, Bruyn GW. Serotonin metabolism in migraine. Neurol. 1989;39:1239-42.
Ortiz A, Cervantes P, Zlotnik G, Velde CVD, Slaney C, Garnham J, et al. Cross-prevalence of migraine andbipolar disorder. Bipolar Disord. 2010;12:397-403.
McIntyre RS, Konarski JZ, Yatham LN. Comorbidity in bipolar disorder: a framework for rational treatment selection. Hum Psycho pharmacol. 2004;19: 369-86.
J. Holland, M. Agius, R. Zaman. Prevalence of co-morbid bipolar disorder and migraine in a regional hospital psychiatric outpatient department. Psychiatria Danubina. 2011;23(1):S23-4.
Birk Engmann. Bipolar Affective Disorder and Migraine Case Reports in Medicine; Volume 2012 (2012), Article ID 389851, 3 pages.
Gunde E, Blagdon R, Hajek T. White matter hyperintensities; From medical comorbidities to bipolar disorders and back. Annals Med. 2011;43(8):571-80.
Bigal M, Liberman JN, Lipton R. Age-dependent prevalence and clinical features of migraine. Neurol. 2006;67:246-51.
Hamel E. Serotonin and migraine; biology and clinical implications. Cephalalgia. 2007;27:1293-300.
Martin VT, Behbehani M. Ovarian hormones and migraine headache; Understanding mechanisms and pathogenesis-part 2. Headache. 2006;6(3):365-86.
Fasmer OB. The prevalence of migraine in patients with bipolar and unipolar affective disorders. Cephalalgia. 2001;21:894-9.
Mathew NT, Reuveni U, Perez F. Transformed or evolutive migraine. Headache. 1987;27:102-6.
De Flippis S, Erbuto D, Gentiti F, Innamorati M, Lester D, Tatarelli R, et al. Mental turmoil, suicide risk, illness perception and temperament, and their impact on quality of life in chronic daily headache. J Headache Pain. 2008;9:349-57.
Verri AP, Cecchini AP, Galli C, Granella F, Sandrini G, Nappi G. Psychiatric co-morbidity in chronic daily headache. Cephalalgia. 1998;18:9-45.
Kececi H, Dener S. Epidemiological and clinical characteristics of migraine in Sivas, Turkey. Headache. 2002;42:275-80.
Bhuvana RC. Prevalence of psychiatric co-morbidity in patients presenting with chronic daily headache; a hospital based cross sectional study. Int J Res Med Sci. 2017;5(1):321-5.
McWilliams LA, Goodwin RD, Cox BJ. Depression and anxiety associated with three pain conditions: results from a nationally representative sample. Pain. 2004;111:77-83.
Marazziti D, Toni C, Pedri S, Bonuccelli U, Pavese N, Lucetti C, et al. Prevalenc of headache syndromes in panic disorder. Int Clin Psychopharmacol. 1999;14:247-51.
Stewart WF, Linet MS, Celentano DD. Migraine headaches and panic attacks. Psychosom Med. 1989;51:559-69.
Cardona-Castrillon GP, Isaza R, Zapata-Soto AP, Franco JG, Gonzalez-Berrio C, Tamayo-Diaz CP. The comorbidity of major depressive disorder, dysthymic disorder and anxiety disorders with migraine. Rev Neurol. 2007;45:272-5.
Guidetti V, Galli F, Fabrizi P, Giannantoni AS, Napoli L, Bruni O, et al. Headache and psychiatric co-morbidity; Clinical aspects and outcome in an 8-years follow up study. Cephalagia. 1998;18:455-62.
Song TJ, Cho SJ, Kim WJ, Yang KI, Yun CH, Chu MK. Anxiety and Depression in Tension-Type Headache: A Population-Based Study. PloS one. 2016;11(10):e0165316.
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. J Neurosci Rural Pract. 2014;5(1):S39-42.
Robbins MS, Crystal SC. New Daily-Persistent Headache Versus Tension-type Headache. Curr Pain Headache Rep. 2010;14:431-5.
Puca F, Genco S, Prudenzano MP, Savarese M, Bussone G, D'Amico D, et al. Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy. The Italian Collaborative Group for the Study of Psychopathological Factors in Primary Headaches. Cephalalgia. 1999;19:159-64.
Holroyd KA, Stensland M, Lipchik GL, Hill KR, O'Donnell FS, Cordingley G. Psychosocial correlates and impact of chronic tension-type headaches. Headache. 2000;40:3-16.
Livingston R, Taylor JL, Crawford SL. A study of somatic complaints and psychiatric diagnosis in children. J American Acad Child Adolesc Psychiatr. 1998;27:185-7.
Last CG. (1991). Somatic complaints in anxiety disordered children. J Anxiety Disord. 1991;5:125-38.
Roberson-Nay R, Eaves LJ, Hettema JM, Kendler, KS, Silber JL. Childhood separation anxiety disorder and adult onset panic attacks share a common genetic diathesis. Depression Anxiety. 2012;29:320-7.
Silove D, Manicavasagar V, Curtis J, Blaszczynski A. Is early separation anxiety a risk factor for adult panic disorder. A critical review. Comprehensive psychiatr. 1996;37(3):167-79.
Beghi E, Allais G, Cortelli P, D'Amico D, De Simone R, d'Onofrio F, et al. Headache and anxiety-depressive disorder comorbidity; The HADAS study. Neurol Sci. 2007;28(2):S217-9.
Cupini LM, De Murtas M, Costa C, Mancini M, Eusebi P, Sarchielli P, et al. Obsessive-compulsive disorder and migraine with medication-overuse headache. Headache. 2009;49(7):1005-13.