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Identification of Patients With Headache at Risk of Psychological Distress


  • Dawn A. Marcus MD

    1. From the Departments of Anesthesiology and Neurology, and the Multidisciplinary Headache Clinic, University of Pittsburgh, Medical Center.
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Address all correspondence to Dr. Dawn A. Marcus, Pain Evaluation and Treatment Institute, 4601 Baum Boulevard, Pittsburgh, PA 15213.


Objective.–To test the hypothesis that anxiety and depression are associated with headache frequency, severity, and disability.

Background.–There is significant comorbidity between chronic headache and psychological 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 attending a university headache clinic were evaluated. Questionnaires about headache symptoms and psychological distress were completed. Comparisons were made between psychological distress and headache frequency, severity, and disability.

Results.–Depression and anxiety were significantly greater in the subjects of this study who had frequent headache (>4 days per week) and frequent headache-associated disability (activities reduced or prohibited because of headache >3 days per week). Subjects who reported their headache severity as typically severe were no more likely to report depression or anxiety than those with mild or moderate headache severity. Quality-of-life measures of physical and social functioning, emotional distress, and general health and vitality were reduced in subjects with frequent episodes of headache-associated disability. All areas, with the exception of general health perception, were reduced in subjects with frequent headache. Severe headache was associated 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 headache severity are less likely to correlate with psychological distress. Therefore, patients with headache who report frequent headache or frequent periods of headache-related disability should be further evaluated for the presence of psychological disturbance.