Depression and Anxiety in Episodic and Chronic Cluster Headache: A Pilot Study

Authors

  • Matthew S. Robbins MD,

    Corresponding author
    1. From The Montefiore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (M.S. Robbins, R. Bronheim, R.B. Lipton, B.M. Grosberg, S. Vollbracht, F.D. Sheftell, and D.C. Buse); North Shore Hebrew Academy High School, Great Neck, NY, USA (R. Bronheim); The New England Center for Headache, Stamford, CT, USA (F.D. Sheftell).
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  • Rachel Bronheim,

    1. From The Montefiore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (M.S. Robbins, R. Bronheim, R.B. Lipton, B.M. Grosberg, S. Vollbracht, F.D. Sheftell, and D.C. Buse); North Shore Hebrew Academy High School, Great Neck, NY, USA (R. Bronheim); The New England Center for Headache, Stamford, CT, USA (F.D. Sheftell).
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  • Richard B. Lipton MD,

    1. From The Montefiore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (M.S. Robbins, R. Bronheim, R.B. Lipton, B.M. Grosberg, S. Vollbracht, F.D. Sheftell, and D.C. Buse); North Shore Hebrew Academy High School, Great Neck, NY, USA (R. Bronheim); The New England Center for Headache, Stamford, CT, USA (F.D. Sheftell).
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  • Brian M. Grosberg MD,

    1. From The Montefiore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (M.S. Robbins, R. Bronheim, R.B. Lipton, B.M. Grosberg, S. Vollbracht, F.D. Sheftell, and D.C. Buse); North Shore Hebrew Academy High School, Great Neck, NY, USA (R. Bronheim); The New England Center for Headache, Stamford, CT, USA (F.D. Sheftell).
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  • Sarah Vollbracht MD,

    1. From The Montefiore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (M.S. Robbins, R. Bronheim, R.B. Lipton, B.M. Grosberg, S. Vollbracht, F.D. Sheftell, and D.C. Buse); North Shore Hebrew Academy High School, Great Neck, NY, USA (R. Bronheim); The New England Center for Headache, Stamford, CT, USA (F.D. Sheftell).
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  • Fred D. Sheftell MD,

    1. From The Montefiore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (M.S. Robbins, R. Bronheim, R.B. Lipton, B.M. Grosberg, S. Vollbracht, F.D. Sheftell, and D.C. Buse); North Shore Hebrew Academy High School, Great Neck, NY, USA (R. Bronheim); The New England Center for Headache, Stamford, CT, USA (F.D. Sheftell).
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  • Dawn C. Buse PhD

    1. From The Montefiore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (M.S. Robbins, R. Bronheim, R.B. Lipton, B.M. Grosberg, S. Vollbracht, F.D. Sheftell, and D.C. Buse); North Shore Hebrew Academy High School, Great Neck, NY, USA (R. Bronheim); The New England Center for Headache, Stamford, CT, USA (F.D. Sheftell).
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  • Study Funding: None.

  • Conflict of Interest: Dr. Robbins and Ms. Bronheim report no disclosures. Dr. Lipton has received personal compensation for activities with Advanced Bionics, Allergan, Inc., AstraZeneca Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb Company, Cierra, Endo, GlaxoSmithKline, Inc., Minster, Merck & Co., Inc., Neuralieve, Novartis, and OrthoMcNeil Pharmaceuticals. He holds stock and/or stock options in Minster Pharma and has received research support from Allergan, Inc., OrthoMcNeil Pharmaceuticals, Minster, Endo, GlaxoSmithKline, Inc., Merck & Co., Inc., Neuralieve, and ProEthics. Dr. Grosberg has received personal compensation for activities with Merck & Co., Inc., and has received research support from Allergan, Inc., St. Jude Medical, OrthoMcNeil Pharmaceuticals, GlaxoSmithKline, Inc., Merck & Co., Inc., Advanced Bionics, Proethics, and Pfizer, Inc. Dr. Vollbracht has nothing to disclose. Dr. Sheftell has served on advisory boards for GlaxoSmithKline, Inc., Merck & Co., Inc., MAP Pharmaceuticals, NuPath, Optinose, and Novartis, has served on the speaker's bureaus for Merck & Co., Inc., and GlaxoSmithKline, Inc., has received grant support from Pfizer and possessed an intellectual property patent for montelukast and leukotriene modifiers for migraine and neuroinflammatory disorders. Dr. Buse has received personal compensation for activities with Allergan, Inc., Endo Pharmaceuticals, MAP Pharmaceuticals, Iroko Pharmaceuticals, and Merck, Inc.

M.S. Robbins, 1575 Blondell Avenue, Suite 225, Bronx, NY 10461, USA, email: marobbin@montefiore.org

Abstract

Background.— In contrast to migraine and tension-type headache, the psychiatric comorbidities of cluster headache (CH) have not been well-studied.

Objective.— We assessed the presence of depression and anxiety in groups of episodic CH (ECH) and chronic CH (CCH) patients and compared CH patients with and without depression and anxiety.

Methods.— Sociodemographics, comorbidities, and selected headache features were ascertained from a clinic-based sample in a cross-sectional fashion from January 2007 to July 2010. Active depression and anxiety were assessed using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) scales.

Results.— Of 49 CH patients, ECH patients (n = 32) had an earlier age of onset and consumed less caffeine than CCH patients (n = 17). Rates of depression as defined by a PHQ-9 score ≥10 were low in both ECH (6.3%) and in CCH (11.8%) with similar mean PHQ-9 scores (3.1 vs 3.7, P = .69). Rates of anxiety as defined by a GAD-7 score ≥10 were also low in both ECH (15.6%) and CCH (11.8%) with similar mean GAD-7 scores (3.8 vs 3.4, P = .76). ECH patients in and out of active attack periods had similar levels of depression and anxiety. Depression and anxiety usually occurred together in ECH and CCH patients. CH patients who were depressed or anxious were more likely to present at a younger age and have attack-related nausea and prodromal symptoms. Depressed CH patients were also more likely to have another pain disorder and had undertaken twice as many prophylactic medication trials.

Conclusion.— In this clinic-based cross-sectional study, ECH and CCH patients had similarly low rates of depression and anxiety. Rates were lower than those reported for both episodic and chronic migraine.

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