Pharmacological Management of Mood and Anxiety Disorders in Headache Patients


  • James L. Griffith MD,

  • Maryam Razavi MD

  • From the Department of Psychiatry and Behavioral Sciences, The George Washington University Medical Center, Washington, DC.

Address all correspondence to Dr. James L. Griffith, Department of Psychiatry 8th Floor, 2150 Pennsylvania Avenue, N.W., Washington, DC 20037.


There is emerging evidence that treatment of comorbid mood and anxiety disorders can improve headache treatment outcome when implemented within a comprehensive program. Effective treatment for comorbid mood and anxiety disorders requires screening headache patients and accurately diagnosing specific psychiatric disorders when present. Specific dual-action antidepressant, anticonvulsant, and atypical antipsychotic medications can serve as dual agents that simultaneously treat both headaches and a mood or anxiety disorder. Serotonin reuptake inhibitors and most other antidepressant, anxiolytic, and mood-stabilizing medications are generally ineffective for headache prophylaxis. However, they can be safely added to a headache regimen for treatment of a comorbid psychiatric disorder. Treatment of comorbid psychiatric disorders in headache patients requires patient education about the psychiatric disorder, its treatment, possible side-effects, and expected benefits. Clinicians need to be sensitive to possible stigma that some patients fear from a psychiatric diagnosis or its treatment.