273: High prevalence of anxiety and depression among chronic headache patients: causative fators, likely.

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary headache, Psychology, Gender/sex differences

Background and Aims: Chronic headache is a common and debilitating problem, especially among women. After the third international classification of headaches has established that mixed and compound types of headaches must be delineated, it was noticed that scalp sensitive neuritis is, when examined, present in almost every migraine patient, also involving inflammation of neck and chest structures. Panic attacks, post-traumatic stress and depression, when routinely investigated in chronic headache patients, is highly prevalent, giving rise to the question of causative role of mind suffering in migraine. We hypothesized that the prevalence of these psychiatric disorders were very high and of a causative role.

Methods: In a sample of 79 consultations in 46 patients with chronic headache, the presence and intensity of inflammation of the nerves of the head and the presence of anxiety and depression were assessed. Knowing that the origin of these nerves is in the face, neck, or scalp (supraorbital, greater and lesser occipital nerves, for example), and gently pressing them will reveal nerve tenderness on the pain map. The diagnosis of psychiatric comorbidities followed the ICD-10 and were seached for all patients, including panic attacks and the last time the event occurred, in addition to current depressive symptoms, to correlate data.

Results: Among the 46 studied individuals, a total of forty (87%) were women and only six persons were men (13%). Results show that the prevalence of anxiety disorder was as high as 93,3% in the patients of mixed/tension headache. The prevalence of depression was 84,4%. Besides this high correlation, it is added that 80% of patients present both psychiatric comorbidities. Only 6,7% were not anxious. The most affected head nerves on palpation were the zigomaticotemporal (74,7%), followed by the supraorbital (77,2%) and the lesser occipital nerves (74,7%). The nerve affection was usually bilateral, with 93,7% of records with scalp involvement.

Conclusions: Migraine is a general name given for a complex disease, which involves both the presence of scalp and neck neuritis (tension type headache) and psychiatric disorders. This is an uncommon assertion, since depression and anxiety, or a post-traumatic suffering or the occurrence of panic attacks, are considered "contributing factors" for headache crises, when there is enough evidence to consider them causative factors in the pathophysiology of migraine and headache progressions. The extremely high correlation between severe headache phenotype, nerve tenderness and anxious or depressive symptoms brings the need for more brain network studies, integrating headache and mental diseases.

References: 1. Guyuron B., et al. The current means for detection of migraine headache trigger sites. Plastic and Reconstructive Surgery, Out 2015. Vol 136, No 4.
2. Becker W. J., et al. Guidelines for primary care management of headache in adults. Cam Fam Physicians.2015;61:670-9.
3. Bendtsen I. Central sensitization in tension-type headache – possible pathophysiological mechanisms. Cephalalgia, 2020, 20, 486 – 508.
4. Tuckey B., et al. Impaired lymphatic drainage and interstitial inflammatory stasis in chronic musculoskeletal and idiopathic pain syndromes: exploring a novel mechanism. Frontiers in pain research. August 2021, Vol 2.
5. Wilke J., et al. What is evidence-based about myofascial chains? A systematic review. Running head: evidence for myofascial chains. Accepted manuscript.
6. Wagner B.A., Moreira Filho P.F. Painful temporomandibular disorder, sleep bruxism, anxiety symptoms and subjective sleep quality among military firefighters with frequent episodic tension-type headache. A controlled study. Arq Neuropsiquiatr 2018:76(6):387-392.
7. Maleki N., et al. Concurrent functional and structural cortical alterations in migraine. Cephalalgia. 2012 June; 32(8).
8. Lucas S, Hoffman JM, Bell KR, et al. Cervicogenic headache among patients with migraine: an analysis of 374 Characterization of headache.
9. Ozan Z.T., Tanik N., Inan L.E. Constipation is associated with tension type headache in woman. Arq. Neuropsiquiatry, 2019; 77(3):161-166.
10. Flores A.M.N., Costa Junior A.L. Modelo biopsicossocial e formulação comportamental: compreendendo a cefaleia do tipo tensional. Psicologia em estudo.2008: 143-151.
11. Krymchantowski A. V., Moreira filho P. F. Cefaleia crônica diária primária. Apresentação clínica. Arq Neuropsiquiatr 2000: 58(2-B): 437-451.
12. Speciali J. G., Fleming N. R. P., Fortini I. Primary headaches:
dysfunctional pains. Rev Dor. 2016; 17 (suppl 1):S2-4.
13. Monteiro JMP, et al. Classificação internacional de cefaleias – 3ª edição – 2014.
14. Galliano S. A., et al. Evidências de revisões sistemáticas Cochrane sobre o tratamento da fibromialgia. Diagn tratamento. 2017;22(4): 184-96.
15. Zandalinas S.I., Fritschi F.B., Mittler R. Global warming, climate change and environmental pollution: recipe for multifactorial stress combination disaster. Trends in plant science. June 2021, vol 26. No 6.
16. Zizek, Slavoj. A atualidade do Manifesto Comunista. Tradução Renan Marques Birro. Petrópolis, RJ: Vozes, 2021.
17. Tomyez N.D., Deibert C.P., Moossy JJ. Cervicomedullary junction spinal cord stimulation for head and facial pain. Headache (2011); 51:418-425.
18. Stankewitz A, Aderjan D, Eippert F, May A. Trigeminal nociceptive transmission in migraineurs predicts migraine attacks. J Neurosci. 2011; 31: 19371943.
19. Maleki N., Oscar-Berman, Marlene. Chronic Pain in Relation to Depressive Disorders and Alcohol Abuse. Brain Sciences, v. 10, n. 11, p. 826, 2020
20. Leoni M., Ferrara S., Cecchini A.P. Chapter 28 – The neurobiology of cluster headache.
21. Pulleda F., Goadsby P.J. Current approach to neuromodulation in primary headaches: focus on vagal nerve and sphenopalatine ganglion stimulation. Curr. Pain headache Rep. (2016) 20:40.
22. Texacalidis P., et al. High cervical spinal cord stimulation for occipital neuralgia: a case series and literature review. Journal of pain research. 2019:25472553.
23. McNamara D. Autonomic disfunction may distinguish posttraumatic headache from migraine. American headache society, annual meeting. July 2018.
24. Lin T., et al. Mechanism of peripheral nerve stimulation in chronic pain. Pain medicine, 21(S1), 2020, S6-S12.
25. Do T. P., Guo S., Ashina M. Therapeutic novels in migraine: new drugs, new hope? The Journal of Headache and Pain. (2019) 20:37.

Presenting Author: Ricardo Jorge Barbosa
Submitting Author: RICARDO JORGE VASCONCELOS BARBOSA

Senior Author: Ricardo Barbosa

IASP 2026 Global Year theme of Neuropathic Pain: No