Identification of patients with headache at risk of psychological distress

Objective.-To test the hypothesis that anxiety and depression are associate d with headache frequency, severity, and disability. Background.-There is significant comorbidity between chronic headache and p sychological distress. Headache associated with anxiety or depression tends to be more severe and often requires supplementary psychological treatment in addition to headache therapy. Therefore, the identification of patients with headache who are at risk of psychological distress is important. Methods.-One hundred twenty-seven consecutive patients with headache attend ing a university headache clinic were evaluated. Questionnaires about heada che symptoms and psychological distress were completed. Comparisons were ma de between psychological distress and headache frequency, severity, and dis ability. Results.-Depression and anxiety were significantly greater in the subjects of this study who had frequent headache (>4 days per week) and frequent hea dache-associated disability (activities reduced or prohibited because of he adache >3 days per week). Subjects who reported their headache severity as typically severe were no more likely to report depression or anxiety than t hose with mild or moderate headache severity. Quality-of-life measures of p hysical and social functioning, emotional distress, and general health and vitality were reduced in subjects with frequent episodes of headache-associ ated disability. All areas, with the exception of general health perception , were reduced in subjects with frequent headache. Severe headache was asso ciated with reductions in role and social functioning. Conclusions.-Frequent headache and frequent disability are associated with depression, anxiety, and impaired quality of life. Reports of typical heada che severity are less likely to correlate with psychological distress. Ther efore, patients with headache who report frequent headache or frequent peri ods of headache-related disability should be further evaluated for the pres ence of psychological disturbance.