Comorbilidades Psiquiátricas Associadas às Cefaleias: a Experiência da Consulta de Ligação

Abstract

Introduction:The comorbidity between headaches and psychiatric disorders is common and may be explained by different mechanisms in terms of uni or bi-directional models, or sharing of genetic and environmental risk factors relating to development of both clinical conditions. The presence of this comorbidity has important implications for patients with headaches and for patients with psychiatric disorders, worsens the clinical situation, increases the risk of chronicity, the pain intensity and the rate of treatment failure. Material and Methods:The authors performed a descriptive, retrospective study of prevalence, involving 250 patients seen in Psychiatry -Headaches liaison consultation, over a period of 3 years, from July 1, 2011 to July 1, 2013. The authors undertook the analysis of the clinical records, in respect to sociodemographic and clinical data, neurological and psychiatric diagnosis and prescribed therapy. Results and Discussion: During this period were made 689 liaison consultations, with a prevalence of female patients (84%) and a mean age of 47 years. The tension type headache (60.8%), migraine (24.8%) and headache attributed to psychiatric disorders (7.2%) were the most prevalent types of headaches. Mood disorders (62%) and neurotic stress related disorders (39.2%) were the most frequent psychiatric diagnoses. The therapeutic intervention in these cases emphasizes the multidisciplinary approach with the collaboration of Neurologist and Psychiatrist, based in psychoeducation, cognitive-behavioral intervention and psychopharmacological treatment. Conclusion:Given the complexity of the clinical picture in cases of comorbidity, the experience of psychiatry liaison consultation and multidisciplinary intervention has proved particularly valuable in treating these patients, configuring itself as the proper treatment of this comorbidity. Keywords: Comorbidity; Headache; Mental Disorders; Psychiatry. INTRODUÇÃOSegundo a Classificação Internacional de Cefaleias da Sociedade Internacional de Cefaleias (ICHD-3 beta),1 estas podem ser divididas em Cefaleias primárias, ou cefaleias secundárias quando ocorrem pela primeira vez em estreita relação temporal com outra alteração que é uma causa reconhecida de cefaleias.As cefaleias primárias compreendem a enxaqueca com ou sem aura, as cefaleias tipo tensão e a cefaleia em salvas, o tipo mais conhecido das cefaleias trigémino-autonómicas. As cefaleias secundárias podem ser devidas a situações de traumatismo crânio-encefálico e/ou cervical, doença vascular craniana ou cervical, perturbação intracraniana não vascular, uso de substâncias ou sua privação, infecção, perturbação da homeostase, perturbação de estruturas cranianas ou faciais e perturbações psiquiátricas. Por fim a parte 3 engloba as neuropatias cranianas dolorosas, outras dores faciais e outras cefaleias.As cefaleias primárias são geralmente conceptualizadas

Psychiatric Comorbidities in Neurologic Hospitalizations in Portugal: A Nationwide Retrospective Observational Study

“…1,34 The coexistence of headache and mental disease appears to worsen the clinical situation and increase the risk of chronicity, pain intensity, and the rate of treatment failure. 1,32 In our study, 28% of patients with a primary diagnosis of headache had at least one psychiatric comorbidity, often in the form of mood and anxiety disorders, in agreement with other studies. 1,32,33,35,36 Some authors suggested that these two psychiatric disorders are approximately two to 10 times more prevalent in patients with migraine than compared to general population.…”

“…1,32 In our study, 28% of patients with a primary diagnosis of headache had at least one psychiatric comorbidity, often in the form of mood and anxiety disorders, in agreement with other studies. 1,32,33,35,36 Some authors suggested that these two psychiatric disorders are approximately two to 10 times more prevalent in patients with migraine than compared to general population. 1,33,35,36 In migraine patients, the prevalence of depressive disorders was variable according to studies and methodology, varying between 6.1% to 73.7%, 1,33 and twice as frequent in patients with chronic versus episodic migraine.…”

“…1,33,35,36 In migraine patients, the prevalence of depressive disorders was variable according to studies and methodology, varying between 6.1% to 73.7%, 1,33 and twice as frequent in patients with chronic versus episodic migraine. 1,32 This prevalence was similar in cluster and tension-type headache. 1,32 Regarding the involved mechanisms, twin studies suggest that about 20% of the variability in both migraine and depression can be attributed to shared genes with a bidirectional pattern.…”

“…1,32 This prevalence was similar in cluster and tension-type headache. 1,32 Regarding the involved mechanisms, twin studies suggest that about 20% of the variability in both migraine and depression can be attributed to shared genes with a bidirectional pattern. 1,37,38 The serotonin (5-HT) system seems to play an important role in the association of these two conditions: a chronic interictal 5-HT availability reduction could predispose to cortical spreading depression and increased sensitivity of trigeminovascular pathways 1,39 ; on the other hand, a polymorphism in the 5-HT transporter gene has been linked to migraine and depression.…”

“…Psychiatric comorbidities in patients with a headache diagnosis are common, and their association is complex since they can have uni-or bi-directional mechanisms or share genetic and environmental risk factors. 1,32,33 According to a recent large genome-wide association study, when compared to other neurological disorders, migraine showed a higher genetic correlation with psychiatric disorders suggesting common genetic bases or pathways. 1,34 The coexistence of headache and mental disease appears to worsen the clinical situation and increase the risk of chronicity, pain intensity, and the rate of treatment failure.…”