Many Chronic Tension Headache Patients Also Have Mood Or Anxiety Disorders

Researchers working on a $1.3 million National Institutes of Health study of chronic tension headaches found that 45 percent of study participants reported they felt depressed, hopeless or anxious nearly every day, according to the study's lead author, Gay Lipchik, an assistant research professor in psychology and a project manager for the NIH study.

"Almost half of our participants meet criteria for a mood or anxiety disorder and often this goes overlooked in treatment," Lipchik says. "Initially, this wasn't part of our grant, but research suggests many people with chronic pain often are depressed, and it's certainly something you want to consider when prescribing treatment."

Researchers weren't able to determine if the psychological problems preceded the onset of the chronic tension headaches or if they were caused by the headaches, Lipchik says, adding that many of the patients have had headaches for so long, they couldn't recall which came first.

"A lot of people have a difficult time separating the two and many of the people don't acknowledge that they have psychological problems or problems managing stress," she says. "It's easier for them to discuss it as a consequence of their headaches."

Between 2 percent and 3 percent of Americans suffer from chronic tension headaches, which are characterized by bilateral pain in the head and neck that can last for 30 minutes or drag on for days, even weeks.

For the study, participants completed a questionnaire that combined measures from three widely used psychological assessment tools, including the Primary Care Evaluation of Mental Disorders.

Patients who reported symptoms of depression or anxiety then took part in a brief, structured interview to determine the frequency of problems such as sleep difficulties, poor appetite, lack of concentration, poor self-image, excessive worrying or feeling anxious and other criteria for depression or anxiety.

Twenty-six percent were diagnosed with a mood disorder, such as major or minor depression or dysthmia, and 32 percent were diagnosed with an anxiety disorder.

"When we separated the chronic tension headache sufferers from participants who had headaches and a mood or anxiety disorder, it appeared that patients with the anxiety or mood disorders really have a more compromised quality of life," Lipchik says.

But getting that information isn't easy, she adds. Most of the study participants diagnosed with mood or anxiety disorders didn't show obvious signs of the problems.

"The people who were severely depressed or anxious were referred to a mental health care professional for treatment, but a lot of these people present well and it was only after our interview and evaluation that we found out how impaired they were," Lipchik says.

Another barrier to easy diagnosis is that many patients refuse to admit they have a psychological problem, which means physicians need to inquire carefully about their patients' mental state.

"Some patients are going to be fairly guarded," Lipchik says. "They've come to you for a medical problem and if you begin asking them about depressive disorders, they may be offended. The trick is to get at the information by asking patients how their chronic tension headaches are affecting their daily lives."

The research was presented June 27 at the annual meeting of the American Association for the Study of Headache in San Francisco.

Other study authors include Kenneth Holroyd, professor of psychology and principal investigator of the NIH project, and Cornelia Pinnell, project manager for the headache study and assistant research professor in psychology, both in the College of Arts and Sciences; Frank O'Donnell, clinical associate professor and Gary Cordingley, associate professor of neurology, both in the College of Osteopathic Medicine; and Michael Stensland and Kimberly Hill, graduate students in psychology, all at Ohio University.

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Contact: Gay Lipchik, (614) 523-7574; glipchik@compuserve.com

Written by Kelli Whitlock, (740) 593-0383; kwhitlock1@ohiou.edu