MIAMI BEACH -- Comorbid psychiatric conditions are common in patients with headache disorders, and can adversely affect the prognosis in patients with such disorders, Alvin E. Lake III, Ph.D., said at a symposium sponsored by the American Headache Society.
However, combined behavioral and drug therapy as well as patient education have been shown to improve outcomes, said Dr. Lake, director of the behavioral medicine division at the Michigan Headache and Neurological Institute, Ann Arbor.
Studies suggest that close to 50% of patients with chronic daily headache have an anxiety and/or mood disorder. In those with medication overuse headaches, the prevalence of mood and anxiety disorders appears to be even higher at 68%, according to one study.
Headache patients with psychiatric disorders also appear to have poorer long-term outcomes than do those with no psychiatric disorder. In one study, 57% of patients with multiple psychiatric disorders had worsening of their headaches over an 8-year period, compared with 7% of those with no psychiatric disorder. In addition, 29% of those with multiple psychiatric disorders experienced improvement, compared with 53% of those with no psychiatric disorder.
It appears that in most cases, the psychiatric disorders preceded the headache disorders. In a study of 41 patients with medication overuse headaches and comorbid psychiatric disorders, the psychiatric disorder preceded the headaches in 76% of those with a major depressive episode, 79% of those with panic disorder, 80% of those with generalized anxiety disorder, 89% of those with substance abuse disorder, and 100% of those with social phobia, Dr. Lake noted.
In addition to mood disorders, which have a genetic component, psychological factors, such as anticipatory fear of pain, and psychosocial factors, such as family and work pressures and a need to function, can drive excessive use of preemptive treatment, which in turn can lead to headache chronicity, he explained.
In one study of headache patients, the use of analgesics at initial assessment was associated with a relative risk of 19.6 for chronic daily headaches at 11-year follow-up, compared with a relative risk of 3.1 in those without analgesic overuse. Daily or weekly analgesic use also elevated the risk for chronic pain; in those who used analgesics more than 15 days per month, the relative risk of chronic migraine was 13.3 and the relative risk of nonmigraine headache was 6.2, compared with those without analgesic overuse.
Differential attention to the headache pain has been shown to modulate the subjective experience of pain, Dr. …