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Cluster headaches

Association with anxiety disorders and memory deficits

From the Department of Psychiatry (Drs. Jorge, Arndt, and Robinson), University of Iowa Hospitals & Clinics, Iowa City, IA; and the Department of Neurology (Dr. Leston), Hospital de Clinicas, Buenos Aires University, Buenos Aires, Argentina.

Address correspondence and reprint requests to Dr. Ricardo E. Jorge, Department of Psychiatry, University of Iowa Hospitals & Clinics, 2887 JPP, 200 Hawkins Drive, Iowa City, IA 52242-1057.

OBJECTIVE: To estimate the frequency of mood and anxiety disorders and to assess memory and executive functions among a representative group of patients with episodic cluster headache (ECH) during the course of an acute episode.

METHODS: We compared 21 patients with ECH with 21 patients with tension headache (TH) matched for age, sex, and educational level. Psychiatric diagnosis was made by a semi-structured interview and Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria. Quantitative measures of depression and anxiety were obtained using the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale (HARS). In addition, all patients received a neuropsychological evaluation to assess basic memory and executive functions.

RESULTS: Of the 21 patients with ECH, 5 (24%) met DSM-IV criteria for an anxiety disorder during the year before the episode. Panic disorder was diagnosed in two patients (10%). The remaining three patients (14%) met criteria for generalized anxiety disorder. Of the 21 patients with TH, 2 (10%) met diagnostic criteria for an adjustment disorder with depressed mood, and 1 (5%) met criteria for an adjustment disorder with mixed anxiety and depressed mood. HARS scores were higher among patients with ECH (Kruskal-Wallis, ² = 4.3, df = 1, p = 0.03). ECH patients also showed significantly lower Auditory Verbal Learning Test scores (Kruskal-Wallis, ² = 6.5, df = 1, p = 0.01).

CONCLUSIONS: When compared with a group of patients with TH, ECH patients showed a higher frequency of anxiety disorders during the year before the onset of headaches and significantly greater HARS scores during the episode. In addition, patients with ECH were selectively impaired in verbal memory.