Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes

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.