Academic journal article Iranian Journal of Psychiatry

Psychiatric Comorbidities and Environmental Triggers in Patients with Chronic Daily Headache: A Lifestyle Study

Academic journal article Iranian Journal of Psychiatry

Psychiatric Comorbidities and Environmental Triggers in Patients with Chronic Daily Headache: A Lifestyle Study

Article excerpt

Several studies have suggested that any comprehensive headache management plan should handle various headache-related comorbidities to lower the burden of the existing medical condition (1). Patients with chronic daily headache (CDH) suffer from several significant psychiatric comorbidities (2). While the patients detest to label their headache with psychiatric terms (3), depression and anxiety have been reported as the most prevalent comorbidities of CDH (4). However, environmental triggers such as traffic, noise, and rapid changes in the weather and altitude may also result in headache (5, 6). Several studies have reported that the patients have also unhealthy lifestyle (7). Sleep disturbances (8), diet, and nutritional triggers are also common in these patients (9). To date, no studies have been published from IR Iran that focused on probable

initiating or exacerbating causes of CDH. Increased psychiatric disorders and CDH among the inhabitants of large cities in IR Iran have been reported in the recent years (10-14). In this study, we investigated the lifestyle of CDH patients living in crowded cities, mostly in Tehran and Karaj, to detect factors related to CDH.

Materials and Method

In this cross sectional survey, we studied patients complaining of CDH (headache on > 15 days/month for >3 months or equal to or more than 180 days/year) based on International Classification of Headache Disorders -3 beta (15) referred by neurologists at a multidisciplinary headache clinic at the Baqiyatallah Hospital located in Tehran, IR Iran.

All patients have been visited earlier and were reassessed during October 2011 to the end of 2014 using in depth psychiatric interviews to find out any psychiatric comorbidity, deviation from the healthy lifestyle, and impact of environmental factors.

At first, a psychiatric interview was carried out by a psychiatrist (A.T.) to differentiate probable psychiatric disorders or comorbidities; patients suspected of having physical pain were reassessed by a pain medicine fellow (M.S.) to rule out any significant organic problems. The participants also agreed to characterize their lifestyle in detail with a checklist by a help of another research member (F.F.) Physical activity was outlined based on the American Heart Association (16) as nutritional triggers (17, 18) stress, and environmental factors (19). The Persian checklist was derived from the above-mentioned sources and its face and content validity were approved by both the research team and Behavioral Sciences Research Center (BSRC) of the Baqiyatallah University of Medical Sciences (BUMS) as the stakeholder and government supervisor. An 11-point (0-10) visual analog scale (VAS) (15) was used to measure the severity of the headache. The scale has previously been employed to assess the severity of chronic daily headache in the country as a reliable and valid tool (20). Inclusion criteria were experiencing headache for at least last 6 months and filling a written informed consent form. Having any major psychiatric problems, malingering, or refusal were defined as exclusion criteria. Patients were followed- up and data completion was carried out through phone calls. Data were analyzed using SPSS software for Windows, Version 18 (SPSS Inc. Chicago, USA, 2009). A value of probability (p value) less than 0.05 was assumed as significance level; and Mann-Whitney U, Chi-Square, and Fisher's exact test were used for data analysis. Informed consent was obtained from the study participants and ethical approval of the work was obtained from Research Ethics Committee of the BSRC.


548 patients who were referred to the clinic were interviewed and 135 were excluded due to the presence of coexisting major psychiatric disorders, considerable organic problems, malingering, or refusal to take part or continue the study. Out of 413 patients, 282 (68.1%) were females. The flowchart of the patients is presented in Figure 1. …

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