Psychiatric disorders, headache comorbidity, and quality of life in a psychiatric outpatient clinic

Comorbidity between headaches and mental disorders in a general psychiatric outpatient clinic is unknown. This study aimed to estimate the prevalence of primary headaches in a psychiatric outpatient clinic and to develop headache occurrence and quality-of-life (QoL) predictive models. In a cross-sectional study, the prevalence of primary headaches was evaluated in a sample of 1014 patients. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria were used to diagnose mental disorders, and the third edition of the International Classification of Headache Disorders (ICHD-3) was used to classify headaches. Other patient variables studied included: (i) mental disorders severity and functionality, using the Clinical Global Impression scale (CGI) and the modified version of the Global Assessment of Functioning scale (mGAF), (ii) headaches’ impact measured by the Headache Impact Test (HIT-6), and (iii) QoL measured by the quality-of-life index EUROHIS-QOL-8. The prevalence of any primary headache in our sample was 60.4%. Tension-type headache was the most frequent (42.5%), followed by migraine (34%) and coexisting migraine and tension-type headache (23.5%). Psychotic patients had a lower prevalence (29.8%). A set of predictors for headaches and QoL was identified. The diagnosis of mood and anxiety disorders predicted both headaches and low QoL, while higher HIT-6 scores were associated with lower QoL. Primary headaches are common in psychiatric practice; in addition, our findings suggest a correlation between higher headache severity and lower QoL among psychiatric patients.