Association of psychiatric co.morbidity and efficacy of treatment in chronic daily headache in Indian population

Ajai Kumar Singh; Rakesh Shukla; Jitendra Kumar Trivedi; Deepti Singh

doi:10.4103/0976-3147.112736

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Original Article

4 (

); 132-139

doi:

10.4103/0976-3147.112736

Association of psychiatric co.morbidity and efficacy of treatment in chronic daily headache in Indian population

Ajai Kumar Singh, Rakesh Shukla¹, Jitendra Kumar Trivedi², Deepti Singh²

Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, India

1Departments of Neurology, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George’s Medical University), Lucknow, Uttar Pradesh, India

2Departments of Psychiatry, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George’s Medical University), Lucknow, Uttar Pradesh, India

Address for correspondence: Dr. Ajai Kumar Singh Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences Vibhuti Khand‑2, Gomti Nagar, Lucknow ‑ 226 010, Uttar Pradesh India ajai.shreshtha@gmail.com

Journal of Neurosciences in Rural Practice

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Abstract

ABSTRACT

Objective: To study the prevalence of psychiatric co‑morbidity in patients of chronic daily headache (CDH) and compare the efficacy of treatment between various type of headache associated with psychiatric co‑morbidity. Materials and Methods: Prospective case control cohort study, 92 consecutive patients of CDH meeting eligibility criteria. The diagnosis of various subtypes of CDH was made according to the IHS criteria. Age, sex, educational, marital and socioeconomic status, matched controls were also selected. Patients were evaluated with the Mini International Neuropsychiatric Interview (MINI) scale at the time of enrolment and at 3 months. Results: CDH accounted for 28% of all headache patients. The mean age of presentation was 30.2 ± 10.3 years, male: Female ratio of 28:64 and mean duration of 4.56 ± 0.56 years. Chronic migraine (CM) accounted for 59 patients, chronic tension type headache (CTTH) 22 patients, new daily persistent headache (NDPH) 3 patients and miscellaneous 8 patients. Psychiatric co‑morbidity was present in 53.3% patients with CDH, and was more common in CM (62.7%) as compared to CTTH (36.4%). Single psychiatric co‑morbidity was seen in 26 patients, while 23 patients had multiple co‑morbidity. Major depressive episode, anxiety disorder, agoraphobia and dysthymia were significant psychiatric co‑morbidities. Patients with CM were treated with topiramate or divalproex sodium ER and CTTH were treated with amitriptyline. 55 patients came for follow up at 3 months, improvement in headache was seen in 29 patients. Conclusion: Psychiatric co‑morbidity was present in more than 50% patients with CDH and its presence along with a duration of ≥2 years was associated with a poor response to treatment.

Keywords

Chronic daily headache

chronic migraine

chronic tension type headache

psychiatric co.morbidity

Show Related Articles from PubMed

Conflict of Interest

None declared

References

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[Google Scholar]
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Juang K. D., Wang S. J., Fuh J. L., Lu S. R., Su T. P., . Co-morbidity of depressive and anxiety disorders in chronic daily headache and its subtypes. Headache. 2000;40:818-23.
[Google Scholar]
Verri A. P., Proletti Cecchini A, Galli C, Granella F, Sandrini G, Nappi G, . Psychiatric co-morbidity in chronic daily headache. Cephalalgia. 1998;18:45-9.
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Mitsikostas D. D., Thomas A. M., . Co-morbidity of headache and depressive disorders. Cephalalgia. 1999;19:211-7.
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Cerbo R, Prudenzano M. P., Barbanti P, . The importance of anxiety and depression as factors in chronicisation of primary headaches. J Headache Pain. 2000;1:S45-54.
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Guidetti V, Galli F, . Psychiatric co-morbidity in chronic daily headache: Pathophysiology, etiology, and diagnosis. Curr Pain Headache Rep. 2002;6:492-7.
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Lake A. E. 3rd, Rains J. C., Penzien D. B., Lipchik G. L., . Headache and psychiatric co-morbidity: Historical context, clinical implications, and research relevance. Headache. 2005;45:493-506.
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Gentili C, Panicucci P, Guazzelli M, . Psychiatric co-morbidity and chronicisation in primary headache. J Headache Pain. 2005;6:338-40.
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Sandrini M, Vitale G, Pini L. A., Sternieri E, Bertolini A, . Effects of chronic treatment with phenazone on the hot-plate test and [3H] serotonin binding sites in pons and cortex membranes of the Rat. Pharmacology. 1993;47:84-90.
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Fishbain D. A., . Approaches to treatment decisions for psychiatric co-morbidity in the management of the chronic pain patient. Med Clin North Am. 1999;83:737-60.
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Katon W. J., . Depression in patients with inflammatory bowel disease. J Clin Psychiatry. 1997;58:20-3.
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Nisbett R. E., Schachter S, . Cognitive manipulation of Pain. J Exp Soc Psychol. 1966;2:227-36.
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Rapoport N. B., McAnulty D. P., Waggoner C. D., Brantley P. J., . Cluster analysis of Minnesota Multiphasic Personality Inventory (MMPI) profiles in a chronic headache population. J Behav Med. 1987;10:49-60.
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Holm J. E., Penzien D. B., Holroyd K. A., Brown T. A., . Headache and depression: Confounding effects of trans-diagnostic symptoms. Headache. 1994;34:418-23.
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Chakravarty A, . Chronic daily headaches: Clinical profile in Indian patients. Cephalalgia. 2003;23:348-53.
[Google Scholar]
Headache Classification Committee of the International Headache Society , . The International Classification of Headache Disorders, 2 nd ed. Cephalalgia. 2004;24:9-160.
[Google Scholar]
Mathew N. T., Reuveni U, Perez F, . Transformed or evolutive migraine. Headache. 1987;27:102-6.
[Google Scholar]
Bigal M. E., Sheftell F. D., Rapoport A. M., Tepper S. J., Lipton R. B., . Chronic daily headache: Identification of factors associated with induction and transformation. Headache. 2002;42:575-81.
[Google Scholar]
Wang S. J., Juang K. D., Fuh J. L., Lu S. R., . Psychiatric comorbidity and suicide risk in adolescents with chronic daily headache. Neurology. 2007;68:1468-73.
[Google Scholar]
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:S217-9.
[Google Scholar]
De Flippis S, Erbuto D, Gentiti F, Innamorati M, Lester D, Tatarelli R, et al . Mental turmoil, suicide risk, illness perception and temperament, and there impact on quality of life in chronic daily headache. J Headache Pain. 2008;9:349-57.
[Google Scholar]
Puca F, . Psychopathological factors in chronic headache: An overview. J Headache Pain. 2000;1:S95-9. Supp l
[Google Scholar]
Cardona-Castrillon G. P., Isaza R, Zapata-Soto A. P., Franco J. G., Gonzalez-Berrio C, Tamayo-Diaz C. P., . The comorbidity of major depressive disorder, dysthymic disorder and anxiety disorders with migraine. Rev Neurol. 2007;45:272-5.
[Google Scholar]
Breslau N, Schultz L. R., Stewart W. F., Lipton R. B., Lucia V. C., Welch K. M., . Headache and major depression: Is the association specific to migraine. Neurology. 2000;54:308-13.
[Google Scholar]
Breslau N, Schultz L. R., Stewart W. F., Lipton R, Welch K. M., . Headache types and panic disorder: Directionality and specificity. Neurology. 2001;56:350-4.
[Google Scholar]
Breslau N, Davis G. C., Andreski P, . Migraine, psychiatric disorders, and sucide attempts. An epidemiological study of young adults. Psychiatry Res. 1991;37:11-23.
[Google Scholar]
Silberstein S. D., Schulman E. A., Hopkins M. M., . Repetitive intravenous DHE in the treatment of refractory headache. Headache. 1990;30:334-9.
[Google Scholar]
Konno S, Meyer J. S., Margishvili G. M., Rauch R. A., Haque A, . Transformed migraine is a cause of chronic daily headaches. Headache. 1999;39:95-100.
[Google Scholar]
Ravishanker K, . Headache pattern in India: A headache clinic analysis of 1000 patients. Cephalalgia. 1997;17:316-31.
[Google Scholar]
Lipton R. B., Hamelsky S. W., Kolodner K. B., Steiner T. J., Stewart W. F., . Migraine, quality of life, and depression: A population-based case-control study. Neurology. 2000;55:629-35.
[Google Scholar]

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[1] Castillo J, Munoz P, Guitera V, Pascual J, . Epidemiology of chronic daily headache in the general population. Headache. 1999;39:190-6.
[Google Scholar]

[2] Silberstein S. D., Lipton R. B., . Chronic daily headache. Curr Opin Neurol. 2000;13:277-83.
[Google Scholar]

[3] Juang K. D., Wang S. J., Fuh J. L., Lu S. R., Su T. P., . Co-morbidity of depressive and anxiety disorders in chronic daily headache and its subtypes. Headache. 2000;40:818-23.
[Google Scholar]

[4] Verri A. P., Proletti Cecchini A, Galli C, Granella F, Sandrini G, Nappi G, . Psychiatric co-morbidity in chronic daily headache. Cephalalgia. 1998;18:45-9.
[Google Scholar]

[5] Mitsikostas D. D., Thomas A. M., . Co-morbidity of headache and depressive disorders. Cephalalgia. 1999;19:211-7.
[Google Scholar]

[6] Cerbo R, Prudenzano M. P., Barbanti P, . The importance of anxiety and depression as factors in chronicisation of primary headaches. J Headache Pain. 2000;1:S45-54.
[Google Scholar]

[7] Guidetti V, Galli F, . Psychiatric co-morbidity in chronic daily headache: Pathophysiology, etiology, and diagnosis. Curr Pain Headache Rep. 2002;6:492-7.
[Google Scholar]

[8] Torelli P, Lambru G, Manzoni G. C., . Psychiatric co-morbidity and headache: Clinical and therapeutic aspects. Neurol Sci. 2006;27:S73-6.
[Google Scholar]

[9] Hamelsky S. W., Lipton R. B., . Psychiatric co-morbidity of migraine. Headache. 2006;46:1327-33.
[Google Scholar]

[10] Heckman B. D., Holroyd K. A., . Tension-type headache and psychiatric co-morbidity. Curr Pain Headache Rep. 2006;10:439-47.
[Google Scholar]

[11] Ferrari M. D., Odnik J, Tapparelli C, Van Kempen G. M., Pennings E. J., Bruyn G. W., . Serotonin metabolism in migraine. Neurology. 1989;39:1239-42.
[Google Scholar]

[12] Karakurum B, Soylu O, Karatas M, Giray S, Tan M, Arlier Z, et al . Personality, depression and anxiety as a risk factor for chronic migraine. Int J Neurosci. 2004;114:1391-9.
[Google Scholar]

[13] Wang S. J., Juang K. D., . Psychiatric co-morbidity of chronic daily headache: Impact, treatment, outcome, and future studies. Curr Pain Headache Rep. 2002;6:505-10.
[Google Scholar]

[14] Lake A. E. 3rd, Rains J. C., Penzien D. B., Lipchik G. L., . Headache and psychiatric co-morbidity: Historical context, clinical implications, and research relevance. Headache. 2005;45:493-506.
[Google Scholar]

[15] Gentili C, Panicucci P, Guazzelli M, . Psychiatric co-morbidity and chronicisation in primary headache. J Headache Pain. 2005;6:338-40.
[Google Scholar]

[16] Sandrini M, Vitale G, Pini L. A., Sternieri E, Bertolini A, . Effects of chronic treatment with phenazone on the hot-plate test and [3H] serotonin binding sites in pons and cortex membranes of the Rat. Pharmacology. 1993;47:84-90.
[Google Scholar]

[17] Fishbain D. A., . Approaches to treatment decisions for psychiatric co-morbidity in the management of the chronic pain patient. Med Clin North Am. 1999;83:737-60.
[Google Scholar]

[18] Katon W. J., . Depression in patients with inflammatory bowel disease. J Clin Psychiatry. 1997;58:20-3.
[Google Scholar]

[19] Nisbett R. E., Schachter S, . Cognitive manipulation of Pain. J Exp Soc Psychol. 1966;2:227-36.
[Google Scholar]

[20] Rapoport N. B., McAnulty D. P., Waggoner C. D., Brantley P. J., . Cluster analysis of Minnesota Multiphasic Personality Inventory (MMPI) profiles in a chronic headache population. J Behav Med. 1987;10:49-60.
[Google Scholar]

[21] Holm J. E., Penzien D. B., Holroyd K. A., Brown T. A., . Headache and depression: Confounding effects of trans-diagnostic symptoms. Headache. 1994;34:418-23.
[Google Scholar]

[22] Sheehan D. V., Lecrubier Y, Sheehan K. H., Amorim P, Janavs J, Weiller E, et al . The Mini International Neuropsychiatric Interview (M.I.N.I.): The development and validatation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22-33.
[Google Scholar]

[23] Lecrubier Y, Sheehan D, Weiller E, . The MINI International Neuropsychiatric Interview (M.I.N.I.): A short Diagnostic Structured Interview: Reliability and Validity according to the CIDI. Eur Psychiatry. 1997;12:224-31.
[Google Scholar]

[24] Sheehan D. V., Lecrubier Y, Harneth-Sheehan K, . Reliability and validity of the MINI International Neuropsychiatric Interview (M.I.N.I.): According to the SCID-P. Eur Psychiatry. 1997;12:232-41.
[Google Scholar]

[25] Chakravarty A, . Chronic daily headaches: Clinical profile in Indian patients. Cephalalgia. 2003;23:348-53.
[Google Scholar]

[26] Headache Classification Committee of the International Headache Society , . The International Classification of Headache Disorders, 2 nd ed. Cephalalgia. 2004;24:9-160.
[Google Scholar]

[27] Mathew N. T., Reuveni U, Perez F, . Transformed or evolutive migraine. Headache. 1987;27:102-6.
[Google Scholar]

[28] Bigal M. E., Sheftell F. D., Rapoport A. M., Tepper S. J., Lipton R. B., . Chronic daily headache: Identification of factors associated with induction and transformation. Headache. 2002;42:575-81.
[Google Scholar]

[29] Wang S. J., Juang K. D., Fuh J. L., Lu S. R., . Psychiatric comorbidity and suicide risk in adolescents with chronic daily headache. Neurology. 2007;68:1468-73.
[Google Scholar]

[30] 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:S217-9.
[Google Scholar]

[31] De Flippis S, Erbuto D, Gentiti F, Innamorati M, Lester D, Tatarelli R, et al . Mental turmoil, suicide risk, illness perception and temperament, and there impact on quality of life in chronic daily headache. J Headache Pain. 2008;9:349-57.
[Google Scholar]

[32] Puca F, . Psychopathological factors in chronic headache: An overview. J Headache Pain. 2000;1:S95-9. Supp l
[Google Scholar]

[33] Cardona-Castrillon G. P., Isaza R, Zapata-Soto A. P., Franco J. G., Gonzalez-Berrio C, Tamayo-Diaz C. P., . The comorbidity of major depressive disorder, dysthymic disorder and anxiety disorders with migraine. Rev Neurol. 2007;45:272-5.
[Google Scholar]

[34] Breslau N, Schultz L. R., Stewart W. F., Lipton R. B., Lucia V. C., Welch K. M., . Headache and major depression: Is the association specific to migraine. Neurology. 2000;54:308-13.
[Google Scholar]

[35] Breslau N, Schultz L. R., Stewart W. F., Lipton R, Welch K. M., . Headache types and panic disorder: Directionality and specificity. Neurology. 2001;56:350-4.
[Google Scholar]

[36] Breslau N, Davis G. C., Andreski P, . Migraine, psychiatric disorders, and sucide attempts. An epidemiological study of young adults. Psychiatry Res. 1991;37:11-23.
[Google Scholar]

[37] Silberstein S. D., Schulman E. A., Hopkins M. M., . Repetitive intravenous DHE in the treatment of refractory headache. Headache. 1990;30:334-9.
[Google Scholar]

[38] Konno S, Meyer J. S., Margishvili G. M., Rauch R. A., Haque A, . Transformed migraine is a cause of chronic daily headaches. Headache. 1999;39:95-100.
[Google Scholar]

[39] Ravishanker K, . Headache pattern in India: A headache clinic analysis of 1000 patients. Cephalalgia. 1997;17:316-31.
[Google Scholar]

[40] Lipton R. B., Hamelsky S. W., Kolodner K. B., Steiner T. J., Stewart W. F., . Migraine, quality of life, and depression: A population-based case-control study. Neurology. 2000;55:629-35.
[Google Scholar]

Association of psychiatric co.morbidity and efficacy of treatment in chronic daily headache in Indian population

Abstract

ABSTRACT

Keywords

Chronic daily headache

chronic migraine

chronic tension type headache

psychiatric co.morbidity

Conflict of Interest

References

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