Assessment of psychiatric comorbidities and disability in patients with a complaint of headache attending psychiatric outpatient department at tertiary care center

Abstract

Background: Headache is one of the most common complaints seen among the patients attending the psychiatric outpatient department. Psychiatric comorbidities worsen the headache and there is a vicious cycle of headache and psychiatric symptoms, aggravating each other. This further complicates headache management so it is better to explore psychiatric symptoms whenever we come across a headache patient. Aims and Objectives: The aim and objective of the study are to assess the psychiatric comorbidities and disability among the patients complaining of headaches. Materials and Methods: This was a cross-sectional study carried out at a tertiary care center. Patients attending the outpatient department with complaints of headaches were enrolled. Psychiatric comorbidities were assessed by using patient health questionnaire-9, generalized anxiety disorder-7 scale, depression, anxiety, and stress 21 scale along with allodynia symptom checklist-12. Disability in the past 3 months was assessed by Migraine Disability Assessment Scale (MIDAS) scale. A semi-structured Performa was used to record sociodemographic details and clinical variables. Results: Majority of the patients (69%) were of the age group 20–40 years. Females (75%) predominated in the study. The average severity of headaches reported by 63% of patients was moderate over Likert's scale. Temple area (73%) was the main location. Throbbing (81%) was the main type of headache. One-third of the patients got compelled to wake at night due to headache attacks. The main premonitory symptoms were depression, irritability, and sensitivity to sound. Other associated symptoms during headache attacks were sensitivity to sound, anxiety, and irritability. Psychological stress was the main provoking factor. The majority of patients (75%) show mild disability in the past 3 months over the MIDAS scale. 25% of the patient-reported moderate depression over the patient health questionare-9 scale. The majority of the patients (85%) reported moderate-to-severe anxiety and nearly half of the patients reported severe stress. Conclusion: Patients with headaches have high chances of associated psychiatric comorbidities that make worse outcomes of each other so it is better to do detailed psychiatric workup and treat them efficiently keeping in view of psychiatric symptoms.

Keywords

• disability
• headache
• premonitory symptoms
• psychiatric comorbidities