Headache and psychiatric comorbidity: clinical aspects and outcome in an 8-year follow-up study

Migraine with juvenile onset changes over time. The existence of prognostic factors is a point of focus. A strict relationship between migraine or tension-type headache (TTH) and psychiatric factors has been suggested, but the exact role and the influence on evolution of headache is unknown. Objective. To analyze the evolution of migraine and TTH and psychiatric comorbidity (P-Co) from 1988 to 1996. Material and method. 100 subjects (40M, 60F; mean age 17.9 years; SD 2.7 years; range 12-26 years) were examined at our Center. The International Headache Society (MS) criteria were employed. Psychometric tests and clinical interviews aided psychiatric diagnosis (DSM-VI-R). SCID (Structured Clinical Interview for DSM-III-R) was employed in 1996. Chi square and logistic regression are used for statistical analysis. Findings. Migraine and TTH change their clinical characteristics, with a high tendency to remission (mostly in males). The presence of P-Co in 1988 is related to a worsening or unchanging situation in 1996. Headache-free subjects did not present any psychiatric disorders in 1996. Anxiety disorders in 1988 are related to enduring of headache. Migraine shows comorbidity with anxiety disorders and depression. Conclusion. P-Co is a notable problem in clinical practice. Diagnostic, prognostic, and treatment implications require a systematic assessment of P-Co.