Therapy for Psychiatric Comorbidities in Patients with Episodic Cluster Headache: A Prospective Multicenter Study

Abstract

Qinlin Liu,1 Yixin Zhang,1 Chuan Hu,2 Dongli Yuan,3 Kuiyun Wang,4 Wen Fan,5 Feibao Pan,6 Qin Li,7 Yunfeng Wang,1 Ge Tan1 1Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Neurology, People’s Hospital of Bishan District, Bishan, People’s Republic of China; 3Department of Intelligent Medical Systems, Chongqing Medical University, Chongqing, People’s Republic of China; 4Department of Neurology, Jintang First People’s Hospital, Sichuan, People’s Republic of China; 5Department of Neurology, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of China; 6Department of Neurology, Suining Central Hospital, Suining, People’s Republic of China; 7Department of Neurology, Chongqing General Hospital, Chongqing, People’s Republic of ChinaCorrespondence: Ge Tan, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, People’s Republic of China, Email [email protected]: To explore changes of depression, anxiety and sleep disturbance in patients with episodic cluster headache inside and outside the attack period and assess the therapy to improve the treatment.Patients and Methods: We prospectively recruited 396 patients from 11 specialized headache outpatients and analyzed their headache characteristics, Hospital Anxiety Depression Scale scores, Pittsburgh sleep quality index scores, and the usage of psychiatric medications during as well as 1 month after the attack period.Results: A total of 220 patients completed the follow-up, 52.73% of whom had anxiety, 47.27% had depression and 49.09% had sleep disturbance inside the attack period. At follow-up, the percentage of these patients significantly decreased to 16.36%, 21.82% and 14.55% in the remission period, respectively (p < 0.05). Antidepressants and mood stabilizers were prescribed to 58.18% of the patients. However, both of the changes of Hospital Anxiety Depression Scale scores after the end of the attack period for anxiety (3.52± 2.91 vs 3.32± 3.09, p =0.61) and depression (3.41± 3.33 vs 2.90± 3.58, P =0.28) were comparable in patients with and without taking these medications. Nocturnal onset of headache was positively correlated with Pittsburgh score (OR=8.71), anxiety (OR=2.33) and depression scores (OR=3.56) (p < 0.05).Conclusion: Depression, anxiety and sleep disturbance were significantly alleviated after the attack period. However, psychiatric medications showed limited effect on depression and anxiety. Additionally, the nocturnal attack may cause anxiety and depression in episodic cluster headache.Keywords: cluster headache, depression, anxiety, sleep disturbance, psychiatric comorbidities

Keywords

• cluster headache
• depression
• anxiety
• sleep disturbance
• psychiatric comorbidities