Positive results of M1 stimulation in other studies, and the absence of significant benefits of active high-frequency rTMS of the DLPFC in the present study, point to M1 as a more promising target than the DLPFC, for larger trials of noninvasive brain stimulation in patients with chronic migraine.

Psychiatric comorbidity, mainly anxiety and depression, are common in chronic migraine (CM). Phobias are reported by half of CM patients. Phobic avoidance associated with fear of headache or migraine attack has never been adequately described. We describe 12 migraine patients with particular phobic-avoidant behaviours related to their headache attacks, which we classified as a specific illness phobia, coined as cephalalgiaphobia. All patients were women, mean age 42, and all had a migraine diagnosis (11 CM, all overused acute medications). Patients had either a phobia of a headache attack during a pain-free state or a phobia of pain worsening during mild headache episodes. Patients overused acute medication as phobic avoidance. It is a significant problem, associated with distress and impairment, interfering with medical care.Cephalalgiaphobia is a possible specific phobia of illness, possibly linked to progression of migraine to CM and to acute medication overuse headache.

INTRODUCTION: Chronic migraine (CM) is a common medical condition affecting 2.4% of the general population. Depression is one of the most frequent comorbid disorders in CM. METHOD: Seventy patients diagnosed with chronic migraine were studied. All patients evaluated filled out the Beck Depression Inventory (BDI). Depression severity was divided into none or minimal depression, mild, moderate, and severe. RESULTS: BDI ranged from 4 to 55, mean 21 ± 10.7. Moderate or severe depression, were present in 58.7% of the patients . Some degree of depression appeared in 85.8% of patients. The BDI scores correlated with pain intensity (p = 0.02). Severe depression was more frequent in patients with comorbid fibromyalgia and in patients reporting fatigue. CONCLUSION: The BDI is an easy tool to access depression in CM patients. Suicide risk assessment is needed in CM patients. Patients with fibromyalgia and fatigue are at even higher risk for severe depression.

-B a c k g round: Comorbidity of chronic migraine (CM) with psychiatric disorders, mostly anxiety and mood disorders, is a well-recognized phenomenon. Phobias are one of the most common anxiety diso rders in the general population. Phobias are more common in migraineurs than non-migraineurs. The clinical profile of phobias in CM has never been studied. Method: We investigated the psychiatric profile in 56 patients with CM using the SCID I/P interview. Results: Lifetime criteria for at least one mental d i s o rder was found in 87.5% of the sample; 75% met criteria for at least one lifetime anxiety disorder and 60.7% of our sample fulfilled DSM-IV criteria for lifetime phobic avoidant disorders. Mood and anxiety s c o res were higher in phobic patients than in non-phobic CM controls. Number of phobias correlated with higher levels of anxiety and depre s s i o n . Conclusion: Phobias are common in CM. Its recognition may influence its management. Early treatment may lead to better prognosis.KEY WORDS: headache, migraine, anxiety, phobias. Fobias, outras comorbidades psiquiátricas e enxaqueca crônicaRESUMO -I n t rodução: As comorbidades psiquiátricas das enxaquecas crônicas são bem conhecidas. As fobias, transtorno ansioso mais comum, são mais prevalentes entre enxaquecosos do que entre não enxaquecosos. O perfil clínico de fobias em uma população enxaquecosa nunca foi estudado. M é t o d o : Estudamos aspectos psiquiátricos de uma população de 56 pacientes com enxaqueca crônica. R e s u l t a d o s :Usando o SCID I/P para o DSM-IV, critérios diagnósticos para ao menos algum transtorno psiquiátrico durante a vida foram preenchidos por 87,5% de nossa amostra, 75% para ao menos um transtorno ansioso e 60,7% para condições fóbicas em algum momento de suas vidas. Os escores de ansiedade e humor foram maiore s e n t re os fóbicos e o número de fobias teve correlação positiva com o grau de ansiedade e depre s s ã o . Conclusão: Fobias são comuns na enxaqueca crônica e seu reconhecimento poderia influenciar seu manejo e melhorar seu prognóstico.

Aims The aim of the present study was to evaluate the association between generalized anxiety disorder, subthreshold anxiety (SubAnx) and anxiety symptoms in the prevalence of primary headache. Methods This cross‐sectional study evaluated 383 people from a Brazilian low‐income community. One‐year prevalence rates of migraine, chronic migraine and tension‐type headache were calculated. Anxiety symptoms were then separated into the following groups (based on DSM‐IV criteria): no anxiety criteria; one anxiety criterion; two anxiety criteria; and generalized anxiety disorder (GAD). The control group (no headaches) was compared with headache sufferers for each anxiety group using an adjusted model controlled for confounding factors. Results GAD was present in 37.0% of participants and SubAnx in 16.6%. Those with SubAnx had a 2.28‐fold increased chance of having migraine; 3.83‐fold increased chance of having chronic migraine, a 5.94‐fold increased chance of having tension‐type headache and a 3.27‐fold increased chance of having overall headache. Some anxiety criteria (irritability, difficulty with sleep, concentration problems, muscle tension and fatigue) had similar prevalence to International Classification of Headache Disorders (ICHD‐II) headache criteria such as unilateral pain and nausea for migraine and chronic migraine. Conclusion Headache sufferers seem to have a high prevalence of anxiety symptoms and SubAnx. In addition, the presence of two or more anxiety criteria (not necessarily fulfilling all the criteria for GAD) was associated with having a headache disorder.

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Background: Psychiatric conditions, mostly anxiety and mood disorders, are common in patients with chronic migraine. There has recently been extensive debate on migraine progression, but little is known about the role of psychiatric disorders in this respect. Objective: In order to evaluate the role of psychiatric disorders in migraine progression, we analyzed the temporal profile of migraine, mood and anxiety disorders, and years since onset of symptoms in chronic migraine (CM) patients. Methods: Fifty CM patients diagnosed according to the International Headache Society (2004) criteria were interviewed and diagnosed for mental disorders using the Structured Clinical Interview for DSM-IV (SCID-I/P). Results: Anxiety disorders preceded the onset of episodic migraine, which was followed by depression and daily headaches. Conclusions: Psychiatric comorbidity evaluation in chronic migraine may lead to better patient management and clinical outcomes. Patients with a history of anxiety, episodic migraine, and depression may be at risk of developing CM. Early treatment of anxiety, mood disorders, and episodic migraine may prevent disease progression to CM.

This study has shown a significant association among chronic migraine and medication overuse with lifetime mood and anxiety disorders in patients of the studied population. No association was found for other researched psychiatric disorders.