Psychiatric comorbidities in patients with headaches

Abstract

Migraine and tension-type headaches are not, in and of themselves, psychiatric disorders. Nevertheless, there is a strong association between these headache diagnoses and a number of psychiatric disorders, especially depression and anxiety. Although most individuals with headaches in the general population do not have comorbid psychiatric disorders, many patients do, especially those presenting to specialty clinics. Moreover, there is some evidence indicating that psychiatric comorbidity is a negative prognostic indicator in children and adults with headache. Thus, the identification and treatment of psychiatric illness is necessary, beginning at an early age. In this study we provide an overview of the current literature on comorbidity of psychiatric illness and the most common headache disorders: migraine; tension type; and “chronic daily headache” (ie, chronic migraine, chronic tension type). We briefly discuss the assessment of psychiatric illness in medical (nonpsychiatric) settings and provide pharmacologic and behavioral treatment recommendations. Finally, we briefly examine the role of behavioral medicine in headache management, which appears to be especially important for headache patients with psychiatric comorbidity.