Somatic symptoms in headache patients: The influence of headache diagnosis, frequency, and comorbidity
Somatic symptoms in headache patients: The influence of headache diagnosis, frequency, and comorbidity
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DOI：
10.1111/j.1526-4610.2004.04192.x
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发表时间：
2004-11-01
期刊：
影响因子：
5
通讯作者：
Burchette, R
中科院分区：
文献类型：
--
作者：
Maizels, M;Burchette, R
背景-众所周知，焦虑和抑郁的情绪障碍与原发性头痛障碍是并存的。其他躯体症状与头痛的共病情况知之甚少。方法-头痛诊所的患者接受了精神疾病初级保健评估(Prime-MD)的筛查，这是一种多维度的精神病学筛查工具。躯体症状的发生率通过头痛诊断、严重头痛的频率和精神诊断进行比较。会诊6个月后获得随访数据。结果：289名患者获得了临床诊断和Prime-MD数据。与发作性偏头痛(4.0)相比，慢性偏头痛(平均5.5天)和慢性日常头痛(6.3，P=.008)患者相关的躯体症状更常见；严重头痛患者每周2天比每周少于或等于2天(6.15比4.15，P<；.001)；而在临床诊断为焦虑或抑郁或两者兼有的患者中，与没有焦虑或抑郁的患者相比，(5.7，P=.05，5.2，每周2天的躯体计数明显更高(P=.01)。140名患者获得了6个月的随访数据。严重头痛频率减少的患者和没有严重头痛频率减少的患者的相关症状都有所减少(平均减少1.0，P=0.01和0.8，P=0.003)。结论：慢性偏头痛和CDH患者的相关躯体症状更常见，严重头痛更频繁，伴有焦虑或抑郁。发作性偏头痛患者的躯体患病率与先前研究的初级保健人群相似。头痛障碍的特征可能是随着头痛，特别是严重头痛变得更加频繁，显示出躯体发病率的增加。
Background.-Mood disorders of anxiety and depression are well known to be comorbid with primary headache disorders. Less is known of the comorbidity of other somatic symptoms with headache.Methods.-Headache Clinic patients were screened with the Primary Care Evaluation of Mental Disorders (PRIME-MD), a multidimensional psychiatric screening tool. The prevalence of somatic symptoms was compared by headache diagnosis, frequency of severe headache, and psychiatric diagnosis. Follow-up data were obtained 6 months after consultation.Results.-Clinical diagnoses and PRIME-MD data were available for 289 patients. Associated somatic symptoms were more frequent in patients with chronic migraine (mean 5.5, P < .001) and chronic daily headache (CDH) (6.3, P = .008) compared to episodic migraine (4.0); in patients with severe headache >2 days per week compared to less than or equal to2 days perweek (6.15 vs. 4.15, P < .001); and in patients with a clinical diagnosis of anxiety or depression, or both, compared to no anxiety or depression, (5.7, P =.05, 5.2, P 2 days per week had significantly higher somatic counts (P = .01).Six-month follow-up data were available for 140 patients. Associated symptoms decreased both for patients with and without decrease in severe headache frequency (mean reduction of 1.0, P = .01 and 0.8, P = .003, respectively).Conclusion.-Associated somatic symptoms are more common in patients with chronic migraine and CDH, with more frequent severe headaches, and with associated anxiety or depression. Patients with episodic migraine have similar somatic prevalence as a previously studied primary care population. The spectrum of headache disorders may be characterized as showing increasing somatic prevalence as headaches, particularly severe headaches, become more frequent.