HEADACHE SYNDROMES AND PSYCHIATRIC-DISORDERS - ASSOCIATION AND FAMILIAL TRANSMISSION

This paper examines the association between psychiatric disorders and headache syndromes in a longitudinal epidemiologic sample of young adu lts who were selected from the general population of Zurich, Switzerla nd- Headache syndromes were defined according to the newly introduced diagnostic criteria of the International Headache Society in 1988. The prevalence rates of psychiatric disorders, according to specific head ache subtypes, were examined both cross-sectionally and longitudinally . In the cross-sectional data, migraine with aura was associated with hypomania, recurrent brief depression, and all of the anxiety disorder s, whereas only the phobic disorders and panic were elevated among sub jects with migraine without aura. Similar findings emerged for the lon gitudinal data, with the exception that major depression was associate d with both subtypes of migraine. Subjects with tension-type headaches did not differ from controls with respect to any of the affective or anxiety disorders in both the cross-sectional and longitudinal data. P rospective study data indicated that the age of onset of anxiety disor ders generally preceded that of migraine and that the onset of affecti ve disorders in the majority of comorbid subjects followed that of the onset of migraine. In order to investigate the mechanism for the asso ciations between anxiety/depression syndromes and migraine, patterns o f co-transmission of migraine and anxiety/depression were examined in data from a controlled family history study of migraine. The results w ere consistent with a syndromic relationship between migraine and anxi ety/depression, rather than their representing discrete manifestations of shared underlying etiology. The implications of these data for res earch and clinical work are discussed.