Psychopathology and headache

Headache patients seen in headache clinics, apart from pain and physical symptoms, commonly present psychological problems of anxio-depressive nature, and in some cases traits of a pathological personnality. It is thus worthwhile to review the present state of knowledge about the comorbidity of psychiatric disorders and migraine, tension type headache, chronic daily headache and transformed migraines. Migraine sufferers in particular have been investigated more thoroughly than patients with other types of headache. Several studies have been conducted on migraine sufferers in the general population diagnosed using well-defined criteria ("International Headache Society" and "American Psychiatric Association"). There is a consensus that migraine sufferers have a higher risk of anxio-depressive disorders than the general population. Some authors also found a higher risk of substance (alcohol, drugs) abuse in migraine sufferers, which is consistent with the abuse of pain-killers commonly noted in patients seen in headache clinics. The patients seen in such clinics are, therefore, not representative of the general population. The coexistence of anxiety and/or depression and analgesic abuse in headache patients has been little explored from an epidemiological point of view. The nature of the link between the two types of disorder remains unknown: cause and effect, common etiological factor. However, it is apparent that the anxio-depressive disorder and analgesic abuse worsens the prognosis of the headache condition and that the treatment of headache in the general sense needs to take account of the underlying psychiatric morbidity rather than be restricted to treatment of the headache per se.