Keriman AKYILDIZ, Mustafa SERCAN, Nebil YILDIZ, Ayşe ÇEVİK, Aysu KIYAN

Is headache only headache? Comorbidity of headaches and mental disorders

Amaç: Baş ağrısına eşlik eden psikiyatrik hastalıkların ve özelliklerinin saptanması. Yöntem: Çalışmamıza nöroloji polikliniğine temel başvuru yakınması baş ağrısı olan hastalar (n=71) ile psikiyatri polikliniğinde psikotik bozukluklar dışında I. eksen psikiyatrik bozukluk tanısı konulan, cinsiyet ve yaş açısından bire bir eşleştirilen hastalar (n=71) alınmıştır. Tüm hastalardan sosyodemografik ve baş ağrısı bilgileri alınmış, hepsine Görsel Kıyas Ölçeği, MINI-Tarama formu uygulandıktan sonra MINI ile psikiyatrik değerlendirmeleri yapılarak psikiyatrik tanıları konulmuştur. Bulgular: Çalışma sonucunda nörolojiye başvuran baş ağrısı grubu ve psikiyatrik hasta grubu arasında sosyodemografik özellikler açısından fark olmadığı, baş ağrısı olanların ailelerinde baş ağrısı öyküsünün belirgin olarak daha çok olduğu bulunmuştur. Baş ağrısı hastalarında psikiyatrik eş tanı sıklığının yüksek (%80.3) olduğu görülmüştür. Gerilim tipi baş ağrısı olanların tümünün MINI ile yapılan görüşmede ağrı bozukluğu tanı ölçütlerini karşıladığı, ağrı bozukluğu dışlandığında da psikiyatrik eş tanı sıklığındaki yüksekliğin (%63.4) devam ettiği gözlenmiş ve en sık rastlanan psikiyatrik eş tanının literatür bilgisiyle uyumlu olarak depresif bozukluklar (%64.8) olduğu görülmüştür. Tartışma: Baş ağrısı hastalarında psikiyatrik eş tanı yüksekliği dikkat çekicidir. Hastaların ailelerinde baş ağrısı öyküsünün belirgin olarak daha çok olması, kişide psikiyatrik bir sorun varlığından bağımsız bir baş ağrısı eğilimini işaret etmektedir. Psikososyal stresör varlığında yüksek eş tanı oranlarının olması, psikososyal stresör, psikiyatrik eş tanı ve baş ağrısı arasında bir süreklilik olduğunu göstermektedir. Psikiyatrik eş tanılar arasında depresif bozukluklar (depresyon) ağırlık taşımaktadır. Öte yandan araştırmamız gerilim tipi baş ağrısı hastalarındaki psikiyatrik eş tanı yüksekliğine dikkat çekmektedir. DSM-IVteki ağrı bozukluğu tanı ölçütleri ile ICHD (International Classification of Headache Disorders) gerilim tipi baş ağrısı tanı ölçütlerinin sınırları belli bir klinik tablo oluşturmamasının araştırmalarda ve hastaların tanı - tedavisinde sorunlara yol açtığı görülmektedir.

Baş ağrısı yalnızca baş ağrısımıdır? Baş ağrısı ile ruhsal bozuklukların eştanısı

Objective: To determine the psychiatric disorders comorbid with headaches and the characteristics of these disorders. Method: Patients who admitted to the neurology outpatient clinic with a main complaint of headache (n=71), and the same number of patients matching with age and sex (n=71) who admitted to the psychiatry outpatient clinic and had a non-psychotic diagnose in axis I were included into the study. Socio-demographic data and information about their headaches were obtained from all patients. The Visual Analog Scale and MINI-scan form were obtained and psychiatric diagnoses were made after the assessment by MINI. Results: There was not any difference between headache and psychiatric patients group in terms of socio- demographic data. Headache history was found higher in the families of headache group than the psychiatric patients group. High prevalence of psychiatric comorbidity was found in patients with headache (80.3%). All of the patients with tension-type headache (TTH) fulfilled the criteria for diagnosing a pain disorder by MINI, and also the high prevalence of psychiatric comorbidity (63.4%) was still taking place after excluding the pain disorder. The most frequent diagnose of psychiatric comorbidity was found as depressive disorders (64.8%) which is compatible with the literature. Discussion: The high prevalence of psychiatric comorbidity with headache is remarkable. More common family history of headache in headache patients than the other group suggests that there is a tendency to have headache independent from a psychiatric disorder in these patients. High comorbidity rate in the presence of psychosocial stressors suggests that there is a continuum among psychiatric comorbidity, headache and psychosocial stressors. Among the psychiatric comorbidity, depressive disorders predominate. On the other hand, the higher frequency of psychiatric comorbidity in patients with TTH is remarkable. It is observed that the uncertainty between the diagnostic criteria of pain disorder in DSM-IV and diagnostic criteria of TTH (Tension Type Headache) in ICHD (International Classification of Headache Disorders) causes some problems both in diagnosing and treatment of patients and also in researches.

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