Primary headaches in patients with generalized anxiety disorder

Although anxiety disorders and headaches are comorbid conditions, there have been no studies evaluating the prevalence of primary headaches in patients with generalized anxiety disorder (GAD). The aim of this study was to analyze the lifetime prevalence of primary headaches in individuals with and without GAD. A total of 60 individuals were evaluated: 30 GAD patients and 30 controls without mental disorders. Psychiatric assessments and primary headache diagnoses were made using structured interviews. Among the GAD patients, the most common diagnosis was migraine, which was significantly more prevalent among the GAD patients than among the controls, as were episodic migraine, chronic daily headache and aura. Tension-type headache was equally common in both groups. Primary headaches in general were significantly more common and more severe in GAD patients than in controls. In anxiety disorder patients, particularly those with GAD, accurate diagnosis of primary headache can improve patient management and clinical outcomes.     

A 22-Year-Old Woman With Chronic Daily Headaches

Tension-type headache is a common clinical complaint occurring in 78% of the general population. Chronic tension-type headache in adult patients is defined as attacks of headaches occurring on at least 15 days per month over a period of at least 3 consecutive months. The association between headaches and psychological factors represents a significant clinical problem that leads to a broader discussion about whether primary headaches could lead to anxiety or whether anxiety symptoms may precipitate primary headaches. This case highlights the positive outcomes associated with the appropriate identification and treatment of a comorbid psychiatric condition.     

Headaches in Insulin-Dependent Diabetic Patients

Headaches affecting 117 insulin-dependent diabetic patients were studied. 50 developed 3 varieties of headaches associated with clinical hypoglycaemic episodes: (1) Brief headaches, contemporaneous with cerebral and autonomic symptoms, were relieved within minutes of ingesting carbohydrates (8 patients). (2) Prolonged headaches outlasting hypoglycaemic symptoms by 1-48 (average 4.3) hours, not relieved by food, occurred in 36 patients; 12 of these also had nausea, vomiting or photophobia. (3) Migraine headache. 11 of the 117 patients were migraineurs: in 6 of the 11 their typical migraines (2 classical and 4 common) were induced by hypoglycaemic episodes. 9 of the 50 had 2 types of headaches, easily distinguished by each subject. In the whole series of 117 patients, 9 had never had a headache in their life. The remainder had headaches associated with premenstrual tension, anxiety, alcohol or other causes.     

Obsessive compulsive disorder and migraine: case report,diagnosis and therapeutic approach

Psychiatric disorders, notably mood and anxiety disorders, are frequently associated with migraine and chronic daily headaches. The obsessive–compulsive disorder (OCD) is included in the spectrum of anxiety disorders and may be a comorbid condition in headache patients. However, little information has been reported in the literature about this association. This is an important issue as OCD may contribute to the development or maintenance of treatment-resistant chronic headaches. In this paper, we describe a young female patient with refractory chronic migraine and OCD. Considerations on diagnosis, management and treatment of these comorbid conditions are presented.     

Relationship between insomnia and headache in community-based middle-aged Hong Kong Chinese women

Limited studies have investigated the prevalence of insomnia symptoms among individuals with different headache diagnoses and the association between insomnia and headache in subjects with comorbid anxiety and depression. A total of 310 community-dwelling Hong Kong Chinese women aged 40–60 years completed a self-administered questionnaire on headache, sleep difficulties, mood disturbances, and functional impairment. About 31% of the sample complained of recurrent headache unrelated to influenza and the common cold in the past 12 months. The percentages of women diagnosed to have migraine, tension-type headache (TTH), and headache unspecified were 8.4, 15.5 and 7.1%, respectively. The most frequent insomnia complaint was “problem waking up too early” (29.4%), followed by “difficulty staying asleep” (28.0%) and “difficulty falling asleep” (24.4%). Women with headaches were significantly more likely to report insomnia symptoms than those without headaches. There were no significant differences among women with migraine, TTH, and headache unspecified in the prevalence of insomnia symptoms. Logistic regression analysis showed that women with insomnia disorder as defined by an insomnia severity index total score ≥8 had 2.2-fold increased risk of reporting recurrent headache, 3.2-fold increased risk of migraine, and 2.3-fold increased risk of TTH, after adjusting for anxiety and depression. Individual insomnia symptoms were not independent predictors. The association between insomnia and headache was stronger in subjects with more frequent headaches. Our findings suggest that insomnia and the associated distress, but not insomnia symptoms alone, is an independent risk factor for recurrent headache in middle-aged women with mixed anxiety, depression and sleep disturbances.     

Somatic symptoms in headache patients: the influence of headache diagnosis, frequency, and comorbidity

BACKGROUND: Mood disorders of anxiety and depression are well known to be comorbid with primary headache disorders. Less is known of the comorbidity of other somatic symptoms with headache. METHODS: Headache Clinic patients were screened with the Primary Care Evaluation of Mental Disorders (PRIME-MD), a multidimensional psychiatric screening tool. The prevalence of somatic symptoms was compared by headache diagnosis, frequency of severe headache, and psychiatric diagnosis. Follow-up data were obtained 6 months after consultation. RESULTS: Clinical diagnoses and PRIME-MD data were available for 289 patients. Associated somatic symptoms were more frequent in patients with chronic migraine (mean 5.5, P<.001) and chronic daily headache (CDH) (6.3, P=.008) compared to episodic migraine (4.0); in patients with severe headache >2 days per week compared to 2 days per week had significantly higher somatic counts (P=.01). Six-month follow-up data were available for 140 patients. Associated symptoms decreased both for patients with and without decrease in severe headache frequency (mean reduction of 1.0, P=.01 and 0.8, P=.003, respectively). CONCLUSION: Associated somatic symptoms are more common in patients with chronic migraine and CDH, with more frequent severe headaches, and with associated anxiety or depression. Patients with episodic migraine have similar somatic prevalence as a previously studied primary care population. The spectrum of headache disorders may be characterized as showing increasing somatic prevalence as headaches, particularly severe headaches, become more frequent.     

Recurrent Headaches in Children: An Epidemiological Survey of Two Middle Schools in Inner City Chicago

Objectives: The aim of this study was to longitudinally evaluate the epidemiological characteristics of headaches in a school‐based, community setting and to determine the impact of headache symptoms on the health of children. Methods: After institutional review board approval, a prospective cohort study was conducted at two Chicago public schools for a period of 6 months. Members of the research team surveyed both schools weekly for headache and other pain symptoms. The students rated each pain symptom on a 5‐point scale from 0 (“not at all”) to 4 (“a whole lot”). Demographic information was collected at the time of enrollment, and all participants were asked to complete age‐appropriate and validated pediatric surveys to assess the severity of concurrent somatic complaints, anxiety symptoms, functional limitations, and quality of life issues. Results: Of the participating children, 89.5% reported at least one headache during the study period. Females experienced more frequent headaches compared with males (P < 0.05). Children reporting headaches had a significantly increased risk of experiencing other troubling somatic symptoms (P < 0.05). Headache severity showed a moderate correlation with increased feelings of anxiety, functional disability, and a diminished quality of life (P < 0.05). Conclusions: School‐aged children commonly experience headaches. Children experiencing headaches are more likely to report other somatic symptoms, feelings of anxiety, functional limitations, and quality of life impairments.     

慢性疲劳综合征与抑郁症、焦虑症患者临床症状的差异

目的分析研究慢性疲劳综合征(CFS)与轻中度抑郁症、焦虑症患者疲劳特征及抑郁、焦虑症状的差异。方法运用疲劳量表-14(FS-14)、汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)对182 例CFS及轻中度抑郁症、焦虑症患者进行测评及统计分析。结果三组患者在躯体疲劳程度、精神疲劳程度及疲劳总分各方面均无显著性差异(P>0.05);CFS组患者可能有抑郁症状的患者为39 例(62.9%),伴有轻中度抑郁症状的患者为23 例(37.1%),未发现肯定没有抑郁症状的患者;CFS组患者可能有焦虑症状的46 例(74.2%),肯定有焦虑症状的16 例(25.8%),未发现肯定没有焦虑症状的患者;CFS组HAMD总分显著低于轻中度抑郁症组(P<0.001),两组在焦虑/躯体化、阻滞两因子中有非常显著性差异(P<0.01),在认识障碍、日夜变化、绝望感各因子中有显著性差异(P<0.05)。CFS组HAMA总分显著低于轻中度焦虑症组(P<0.001),两组在精神性焦虑方面有非常显著性差异(P<0.01),在躯体性焦虑各方有显著性差异(P<0.05)。结论CFS与轻中度抑郁症、焦虑症三组患者在临床中均表现为“郁”与“疲”的同时存在,在临床症状的表现上存在着一定的“相互重叠”现象。     

Headache in Ehlers-Danlos syndrome

OBJECTIVE: Ehlers-Danlos Syndrome (EDS) is a complex hereditary connective tissue disorder with neurologic manifestations that include cerebrovascular disorders and chronic pain. The clinical data collected on 18 patients with EDS and chronic headaches is reported. PROCEDURE: Clinical history, neurologic examination, computerized tomography of the head, magnetic resonance imaging (MRI) of the brain, and electroencephalogram (EEG). Headaches were classified according to the International Headache Society and the patients were followed by the author for a minimum of 2 years. FINDINGS: Four patients had migraine with aura, four had migraine without aura, four had tension headaches, four had a combination of migraine and tension headaches, and two had post-traumatic headaches. Nine patients exhibited blepharoclonus but none had history of seizures and their EEGs were normal, ruling out eye closure epilepsy. Although one patient had a small right frontal angioma, a second had Arnold Chiari malformation type I, and a third had an old stroke, headaches did not clinically correlate with their central nervous system (CNS) lesions. CONCLUSION: Chronic recurrent headaches may constitute the neurologic presentation of EDS in the absence of structural, congenital, or acquired CNS lesions that correlate with their symptoms. Individuals with EDS may be prone to migraine due to an inherent disorder of cerebrovascular reactivity or cortical excitability. Additional studies are needed to elucidate the pathogenesis of headaches in EDS.     

药物联合催眠疗法治疗广泛性焦虑症对照研究

目的 评价药物联合催眠疗法治疗广泛性焦虑症的临床疗效.方法 将70例广泛性焦虑症患者随机分为两组,每组35例,两组均予以广泛性焦虑症常规药物治疗,研究组联合催眠治疗,观察3个月.于治疗前及治疗3月末,采用焦虑自评量表评定焦虑状况,抑郁自评量表评定抑郁状况,同时统计胸闷、气紧、乏力、心悸等症状的发生率.结果 治疗后两组焦虑自评量表、抑郁自评量表总分均较治疗前有显著下降(P＜0.01),研究组较对照组下降更显著(t=5.19、5.85,P＜0.01);两组胸闷、气紧、乏力、心悸等躯体症状检出率均较治疗前显著下降(P＜0.01);但研究组胸闷、气紧检出率显著低于对照组(χ2=8.93、9.04,P＜0.01).结论 药物联合催眠疗法能显著改善广泛性焦虑症患者的焦虑抑郁情绪,缓解躯体化症状,提高患者的生活质量,显著优于单用常规药物治疗.     

Pharmacological Management of Mood and Anxiety Disorders in Headache Patients

There is emerging evidence that treatment of comorbid mood and anxiety disorders can improve headache treatment outcome when implemented within a comprehensive program. Effective treatment for comorbid mood and anxiety disorders requires screening headache patients and accurately diagnosing specific psychiatric disorders when present. Specific dual-action antidepressant, anticonvulsant, and atypical antipsychotic medications can serve as dual agents that simultaneously treat both headaches and a mood or anxiety disorder. Serotonin reuptake inhibitors and most other antidepressant, anxiolytic, and mood-stabilizing medications are generally ineffective for headache prophylaxis. However, they can be safely added to a headache regimen for treatment of a comorbid psychiatric disorder. Treatment of comorbid psychiatric disorders in headache patients requires patient education about the psychiatric disorder, its treatment, possible side-effects, and expected benefits. Clinicians need to be sensitive to possible stigma that some patients fear from a psychiatric diagnosis or its treatment.     

Psychological symptoms in IBS

Patients with irritable bowel syndrome (IBS) have chronic abdominal symptoms and their health perceptions are impaired though the causes of their symptoms are not explained by routine examinations. IBS patients often show psychological symptoms represented by anxiety and depression, and many of them have the complication of anxiety disorder including panic disorder, depressive disorder, PTSD and so on. In our experience, 27% of IBS patients have the co-morbidity of panic disorder, and these two disorders exacerbated symptoms each other. Such condition impairs health-related quality of life in IBS patients. Psychological and behavioral therapy may benefit in symptomatic relief in IBS patients, suggesting strong participation of phsycological aspects in IBS patients.     

Clinical manifestations of migraine

Migraine is a disorder with many clinical manifestations that vary from person to person and often from headache to headache in the same person. Several body organ systems are involved in a migraine attack. It is a condition that is underdiagnosed by physicians and misidentified by persons suffering with headaches. Many individuals with migraine self-diagnose as having sinus headaches or tension headaches. This article discusses the many symptoms of migraine and will help the busy practitioner to better recognize and diagnose this common disorder.     

Clinical manifestations of migraine

Migraine is a disorder with many clinical manifestations that vary from person to person and often from headache to headache in the same person. Several body organ systems are involved in a migraine attack. It is a condition that is underdiagnosed by physicians and misidentified by persons suffering with headaches. Many individuals with migraine self-diagnose as having sinus headaches or tension headaches. This article discusses the many symptoms of migraine and will help the busy practitioner to better recognize and diagnose this common disorder.     

‘I have anxiety,but I have values and preferences’ Experiences of users with generalized anxiety disorder: A qualitative study

To understand the experience and perceptions of people diagnosed with generalized anxiety disorder, along the whole process and their role through the decision‐making process for their treatment. A qualitative study through focus groups composed of people diagnosed with generalized anxiety disorder was carried out. Content analysis was carried out to explore the most representative issues. Five thematic categories were identified: onset of the disorder, symptoms and course; daily life with the disorder; coping with the disorder; demand of healthcare for anxiety, and treatment options and decision‐making. Most of the patients reported physical symptoms of anxiety. The majority of participants perceived little social support from their environment and occupational interferences. Coping seems to differ among participant that have recovered or not recovered. The involvement of users with generalized anxiety disorder was scarce, and pharmacological treatment was always the first option offered. There is scarce orientation to elicit preferences and values of patients across the process of care for people with generalized anxiety disorder. The consequence is a biased predisposition of the healthcare system to provide pharmacological treatment as the first option and ignore the perspective of patients on how to cope with their illness.     

Examination of anxiety, hostility and psychiatric disorders in patients with migraine and tension-type headache

The role of psychological factors related to headache has long been a focus of investigation. The aim of this study was to evaluate anxiety, depression, hostility and psychological symptoms in patients with migraine and tension-type headache (TTH) and to compare the results with healthy controls. Seventy-five subjects with migraine and 55 subjects with TTH (according to the criteria of the International Headache Society classification) and a control group including 73 healthy subjects were studied. The Buss-Durkee Hostility Inventory, Brief Symptom Inventory, State-trait Anxiety Inventory, Trait form were administered to the subjects. Compared with healthy controls, the patients with headache had significantly higher scores on measures of anxiety, depression and hostility and lower scores on psychological symptoms. The present results indicate the need to distinguish the unique dimensions of anxiety, depression and hostility that should be assessed in the population with headaches.     

烧伤患者焦虑及抑郁障碍的药物治疗

目的 :研究抗焦虑和抗抑郁药物治疗对烧伤患者的焦虑障碍和 /或抑郁障碍的临床疗效 ,为建立合理的烧伤后心理治疗模式充实内容。方法 :选用焦虑自评量表 (SAS)、抑郁自评量表 (SDS)、Hamilton焦虑量表 (HAMA)以及抑郁量表 (HAMD)对 2 2 0例烧伤住院患者进行筛选 ,将 6 6例具有焦虑障碍和 /或抑郁障碍的烧伤患者分为治疗组和对照组 ,治疗组患者根据其焦虑或抑郁症状给予抗焦虑和抗抑郁药物治疗。结果 :治疗组患者的HAMA焦虑量表及HAMD抑郁量表的分值下降明显 ,有显著性差异 (P <0 .0 1)。结论 :精神障碍是烧伤患者不可忽视的并发症之一 ,抗焦虑和 /或抗抑郁药物治疗能够明显改善烧伤患者的焦虑障碍和 /或抑郁障碍     

The role of anger and depression in recurrent headache

Individuals with tension-type headache report significant anger, depression, anxiety, and stressors. However, it is not clear to what extent these variables are interrelated. The objective of the present study was to explore the role of anger in headaches, and to examine its relationship to anxiety, depression, and daily life stressors. Participants were 65 young adult women who suffered from recurrent headaches. The sample was obtained in a large-scale screening of young adult women using the Headache Symptoms List to identify those with recurrent headache. Those individuals reporting headaches completed a battery of assessment measures that included the State-Trait Anger Expression Inventory, the Mood and Anxiety Symptoms Questionnaire, and the Hassles Scale. Results revealed a significant relationship between anger suppression and depression (r = 0.40, P<.01), as well as anger expression and anxiety (r = 0.41, P<.01) for those with headache. The use of the Mood and Anxiety Symptoms Questionnaire allowed for the separate analysis of general distress symptoms and symptoms more specific to anxiety and depression. Results indicated that those with headache experience more general, nonspecific distress rather than symptoms indicative of anxiety and depression (P<.01). In addition, the mixed headache group scored high on both general (mean, 28.96) and specific measures of depression (mean, 65.76) and on anger suppression (mean, 20.12), suggesting that they might experience more psychological distress than those with tension-type headache. The present results indicate the need to distinguish the unique dimensions of anxiety and depression that should be assessed in the population with recurrent headache.     

Cluster headaches and sleep disorders

Cluster headaches are characterized by unilateral paroxysmal attacks of severe pain with associated symptoms. The headaches occur during particular sleep stages and are associated with other chronobiologic factors. Several sleep disorders have been associated with the occurrence of cluster headache; multiple hormonal influences affect the relationship between sleep and headache. Melatonin and other treatments that affect circadian rhythm have been suggested for the treatment of cluster headache. Obstructive sleep apnea can occur in patients with cluster headache; attempts to treat one disorder may influence the other. Sleep disorders such as insomnia and narcolepsy also may be associated with and influence cluster headaches. This article examines the relationship between the various sleep disorders and cluster headache, and reviews current research. Normal and abnormal sleep and details of treatments for specific sleep disorders that may decrease the frequency and severity of cluster headaches also are discussed. The relationship between obstructive sleep apnea, which is the most common sleep disorder, and cluster headache is discussed in detail.     

Irritable bowel syndrome. Toward a biopsychosocial systems understanding

The symptoms of irritable bowel syndrome (IBS) are usually a subset of a broader problem that meets DSM-III criteria for depression, anxiety disorder, somatization disorder, or adjustment disorder. A biopsychosocial perspective that addresses multigenerational family patterns of anxiety, depression, and somatization of stress suggests guidelines for understanding and treating patients with IBS symptoms. Effective treatment focuses primarily on helping patients cope with emotional disorders and psychosocial stressors, and secondarily on direct symptom relief. Psychotherapy is a valuable adjunct to medical treatment. The medications most likely to yield lasting benefits are the antidepressants.