Psychiatric aspects of headache, co-morbid psychiatric disorders, and conditions susceptible to somatization

Complaint of headache causes social stress and financial burden as well as development of individual distress because they are widespread symptoms and disorders. Psychiatric comorbidity complicates the management of headache and incates a poorer prognosis for the treatment of headache. Patients with chronic headache accompanied by depression/anxiety disorder are reported to have significantly more somatic symptoms.This study aims to examine psychological problems accompanying or causing headache in a large number of patients with complaints of headache, the frequency of somatic symptoms in patients with headache, their relationship to psychological problems, and the effects of the attributional styles for somatic symptoms.Patients (n=71) whose chief complaint during consultation in Abant Izzet Baysal Universty, Faculty of Medicine neurology outpatient clinic was headache and patients (n=71) who were diagnosed with axis I psychiatric disorder other than psychotic disorders and whose ages were similar with each other and who were matched up in terms of gender were included into our study. After scales including SCL-90-R somatic symptom items, Visual Analog Scale (VAS), Somatosensory Amplification Scale (SSAS), Symptom Interpretation Questionnaire (SIQ), MINI-Scan forms, were applied to all patients, psychiatric evaluations were performed by MINI and they were psychiatrically diagnosed.The results of the study showed that there were no significant differences in sociodemographic characteristics between the group of patients with neurological headache and the group of psychiatric patients, and that the family of patients with headache had significantly higher rates of the story of headache (p=0.002).It was observed that frequency of psychiatric co-morbidity is higher (80.3%) in the patients with headache. It was found in the interview performed in patients with tension type headache by MINI that they met the diagnosis criteria of pain disorder and increased frequency of psychiatric comorbidity (63.4%) continued when pain disorder was excluded; and it was identified that the most common diagnosis was depressive disorders (64.8%) in line with the literature. As well as there was no difference in terms of subscale scores of SIQ, it was found that the group of psychiatric consultation tended to use more psychologizing attributes, but statistically significant psychologizing attributes was used for palpitation, exhaustion and stomach pain. It was found that the use of normal attributes was significantly higher for headache symptom in the group of headache.Consequently, increased psychiatric comorbidity in the patients with headache is remarkable. Significantly more headache story in families of these patients point out a tendency of headache which is independent from existence of psychiatric problems. A high comorbidity ratio with psychosocial stressor shows that continuity is present among psychosocial stressor, psychiatric comorbidity and headache. Among psychiatric comorbidities, depressive disorders (depression) are dominant. On the other hand, our studies remark increase in the psychiatric comorbidity in patients with headache. It is observed the thing that diagnosis criteria of pain disorder in DSM-IV and diagnosis criteria of tension type headache in ICHD fails to form a certain clinical picture causes problems in researches and in diagnosis treatment of patients.