Aim and Objectives: To study the socio-demographic and clinical profile of patients with chronic migraine headache, and to study the frequency and pattern of co-morbid psychiatric illnesses amongst these patients. Methodology: The study was done at the headache clinic in the Department of Psychiatry at Universal College of Medical Sciences, Bhairahawa, Nepal. All out-patients attending our clinic over a period of three months and aged between 15 to 55 years with a diagnosis of chronic migraine headache were included in the present study. Demographic and clinical profiles of these patients were noted in a specially designed socio-demographic and clinical data sheets prepared for the present study. Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used as diagnostic instrument; Hamilton Rating Scales for Anxiety & Depression (HAM-A, HAM-D) were used to rate the severity of Anxiety and Depressive symptoms. Simple statistical procedures like frequency, percentages, ‘t’-tests and chi-square tests were used for analysis of data thus obtained. Results: A total no of 48 cases of chronic migraine were included in the present study. Forty one cases (85.4%) were female and rest 7 patients were male. Comorbid psychiatric illness was present in thirty one (64.6%) cases among which Anxiety was the most common diagnosis (35.4%) followed by depressive disorders (29.2%). Conclusion: chronic migraine headache has high rate of co-morbid mood and anxiety disorder. Effective treatment of chronic migraine headache requires screening and accurately diagnosing specific psychiatric disorders when present. DOI: http://dx.doi.org/10.3126/jpan.v3i1.11345 J Psychiatrists’ Association of Nepal Vol .3, No.1, 2014: 3-9
Background:Chronic daily headache (CDH) patients respond better with a combination of anti-migraine and anti-stress medications, irrespective of clinical diagnosis of chronic migraine (CM) or chronic tension-type headache (CTTH).Hypothesis:“CDH: Mix headache” type is a valid clinical entity.Materials and Methods:A total of 70 participants fulfilling the diagnosis of “primary CDH”, aged between 15 and 55 years were taken up for the present study. All these patients were subdivided into either CM or CTTH, based on the predominance of symptom profiles in these patients, in confirmation with the International Headache Society guidelines (International Classification of Headache Disorders-2, 2004). Schedules for clinical assessment in neuropsychiatry (SCAN) were applied to these patients to collect information about any mental or behavioral symptoms present at the time of the study. Psychiatric comorbidity was confirmed according to the International Classification of Diseases (ICD)-10.Results:Forty-eight (68.6%) patients could be differentiated into CM and rest 22 (31.4%) patients were given a diagnosis of CTTH. SCAN and ICD-10 diagnosis revealed the presence of comorbid anxiety and depressive illness in 47 (67.2%) patients. Thirty-four of them belonged to CM (MH) group and the rest 13 had CTTH.Discussion:We propose that these 47 (67.2%) patients of CDH form our special category of “CDH - mix headache” subtype. Thus, 14 (20%) patients constitute “CDH - migraine” subtype and rest 9 (12.8%) patients have a diagnosis of “CDH - tension headache” subtype.Conclusion:Findings of the present study validate the concept of “mix headache” and explains the clinical observation that chronic daily headache (CDH) patients responds better with a combination of anti-migraine and anti-stress medications.
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