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High prevalence of somatic symptoms and depression in women with disabling chronic headache

From The University of Toledo (G.E.T., F.H., N.A.H., C.U., S.A.K.), OH; Nashville Neuroscience Group (J.L.B.), TN; The University of Utah (K.B.D., S.B.), Salt Lake City; The University of Cincinnati (V.M.), OH; The University of Iowa (A.R., L.O.G.), Iowa City; and Swedish Medical Center (S.K.A.), Seattle, WA.

Address correspondence and reprint requests to Dr. Gretchen E. Tietjen, 3120 Glendale Avenue, RHC 1450, Department of Neurology, The University of Toledo–Health Science Campus, Toledo, OH 43614; e-mail: gtietjen{at}meduohio.edu

Objective: To better define, in women with headache, the relationship of depression and somatic symptoms to headache, characterized by diagnoses, frequency, and disability.

Methods: At six headache specialty clinics, women with headache were classified using ICHD-II criteria, and frequency was recorded. A questionnaire addressing demographics, age at onset of headache, headache-related disability, somatic symptom, and depression severity was completed. Logistic regression was performed to measure the associations of headache frequency and headache-related disability with somatic symptom and depression severity.

Results: A total of 1,032 women with headache completed the survey, 593 with episodic (96% with migraine) and 439 with chronic headache (87% with migraine). Low education and household income was more common in chronic headache sufferers and in persons with severe headache disability. Somatic symptom prevalence and severity was greater in persons with chronic headache and with severe headache-related disability. Significant correlation was observed between PHQ-9 and PHQ-15 scores (r = 0.62). Chronic headache, severe disability, and high somatic symptom severity were associated with major depressive disorder (OR = 25.1, 95% CI: 10.9 to 57.9), and this relationship was stronger in the subgroup with a diagnosis of migraine (OR = 31.8, 95% CI: 12.9 to 78.5).

Conclusions: High somatic symptom severity is prevalent in women with chronic and severely disabling headaches. Synergistic relationship to major depression exists for high somatic symptom severity, chronic headache, and disabling headache, suggesting a psychobiological underpinning of these associations.

Funded in part by the American Headache Society.

Disclosure: The authors report no conflicts of interest.

Received June 1, 2006. Accepted in final form September 28, 2006.

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