• secondary headache;
  • psychiatric disorder;
  • psychiatric comorbidity;
  • somatoform disorder

(Headache 2011;51:789-795)

Objective.— We describe a sample of patients receiving a diagnosis of headache attributed to psychiatric disorder (HSPD).

Background.— The international literature to date provides only a few case reports of patients presenting with HSPD.

Method.— A retrospective study of the medical records of all patients having received HSPD when consulting at a headache emergency center during 2009.

Results.— Out of a total of 8479 patients seen during one year, 25 men and 62 women received an HSPD diagnosis (1.02%), mean age 40.3 ± 14 years. The psychiatric disorders concerned were: depressive disorder (n = 37), generalized anxiety (n = 25), panic disorder (n = 5), psychotic disorder (n = 5) undifferentiated somatoform disorder (n = 4), somatization disorder (n = 1), and posttraumatic stress disorder (n = 1). Data were missing for 10 patients. Whether the headache had occurred only during the evolution of a psychiatric disorder was not recorded for any of the patients. Headache description was tension type (n = 45), atypical (n = 23), and migraine (n = 19). Half of the sample were chronic daily headaches (n = 44), but only 14.8% (n = 13) presented with medication overuse. One-fourth of the patients suffered from pain in other parts of the body (n = 21), 40% had already had complementary investigations and consultations for their headache.

Conclusion.— This study shows that in practice HSPD diagnosis is rarely used. When used, International Classification of Headache Disorders, 2nd edition criteria are not strictly applied. The criterion “headache occurring only during the evolution of the psychiatric disorder” is not checked. Not only are atypical headaches considered but, in the majority of cases, HSPD diagnosis is given with tension-type or migraine-type headache. Even though psychotic disorder and somatization disorder are the only psychiatric disorders accepted for HSPD in the classification itself (International Classification of Headache Disorders, 2nd edition code 12), in clinical practice they are not frequently involved whereas depression and generalized anxiety are. It may call for the removal of those appendix diagnoses in the classification itself.