Objective.-To investigate the frequency of depressive and anxiety disorders
in patients with chronic daily headache.
Background.-There is a lack of data in the literature on the extent of psyc
hiatric comorbidity in patients with different subtypes of chronic daily he
adache.
Methods.-We recruited consecutive patients with chronic daily headache seen
in a headache clinic from November 1998 to December 1999. The subtypes of
chronic daily headache were classified according to the criteria proposed b
y Silberstein et al. A psychiatrist evaluated the patients according to the
structured Mini-International Neuropsychiatric Interview to assess the com
orbidity of depressive and anxiety disorders.
Results.-Two hundred sixty-one patients with chronic daily headache were re
cruited. The mean age was 46 years, and 80% were women. Transformed migrain
e was diagnosed in 152 patients (58%) and chronic tension-type headache in
92 patients (35%). Seventy-eight percent of patients with transformed migra
ine had psychiatric comorbidity, including major depression (57%), dysthymi
a (11%), panic disorder (30%), and generalized anxiety disorder (8%). Sixty
-four percent of patients with chronic tension-type headache had psychiatri
c diagnoses, including major depression (51%), dysthymia (8%), panic disord
er (22%), and generalized anxiety disorder (1%). The frequency of anxiety d
isorders was significantly higher in patients with transformed migraine aft
er controlling for age and sex (P =.02). Both depressive and anxiety disord
ers were significantly more frequent in women.
Conclusion.-Psychiatric comorbidity, especially major depression and panic
disorders, was highly prevalent in patients with chronic daily headache see
n in a headache clinic. These results demonstrate that women and patients w
ith transformed migraine are at higher risk of psychiatric comorbidity.