A Review of Screening Tools for Psychiatric Comorbidity in Headache Patients

Abstract

Psychiatric comorbidity, especially depression and anxiety, has been well documented in patients with primary headache disorders. The presence of psychiatric comorbidity in headache patients is associated with decreased quality-of-life, poorer prognosis, chronification of disease, poorer response to treatment, and increased medical costs. Despite the prevalence and impact, screening for psychiatric disorders in headache patients is not systematically performed, either clinically or in research studies, and there are no guidelines to suggest which patients should be screened or in what manner. We review a variety of screening methods and instruments, focusing primarily on self-report measures and those available in the public domain. Informal verbal screening may be sufficient in a primary care setting, but should include screening for both anxiety and depression. Explicit screening for anxiety is important, as anxiety may have a more significant impact on headache than does depression and may occur in the absence of clinical depression. Formal screening with instruments that can identify a variety of psychiatric disorders is appropriate for patients with daily headache syndromes, patients who are refractory to usual care, and patients referred for specialty evaluation. Limitations of screening instruments include the influence of transdiagnostic symptoms and the need for confirmatory diagnostic interview. The following instruments appear most suitable for use in headache patients: for depression,

Behavioral medicine for migraine and medication overuse headache

“…Maizels et al [44] reviewed brief screening instruments that are useful for assessing the presence of depression and anxiety. The Patient Health Questionnaire (PHQ)-2 is a 2-item instrument that serves as an effective screen for the presence of depression [45].…”

Anxiety and depression in headache patients

“…In zahlreichen epidemiologischen Stu dien und klinischen Forschungen wur de ein erhöhtes Risiko für affektive Stö rungen und Angststörungen bei Patien ten mit Migräne und chronischen täg lichen Kopfschmerzen nachgewiesen [16,20,21,22,26]. Dabei sind die Prävalenz raten für Angsterkrankungen sogar noch höher als für depressive Störungen [3,4].…”

“…Patienten mit chronischer Migräne und täglichem Nichtmigränekopfschmerz zeigen mehr Anzeichen von Depressivi tät und Angst als solche mit episodischer Migräne [22], vielleicht auch deshalb, weil z. B. Angst die Schmerzschwelle und to leranz senkt [12].…”

Childhood Maltreatment in the Migraine Patient

“…Brief screening instruments can be used to assess depression and anxiety [101]. The PHQ-2 is a two-item screening instrument that has been empirically shown to detect the presence of depression with two questions [102].…”