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      Headache, depression and anxiety: associations in the Eurolight project

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          Abstract

          Background

          Headache disorders and psychiatric disorders are both common, while evidence, mostly pertaining to migraine, suggests they are comorbid more often than might be expected by chance. There are good reasons for establishing whether they are: symptoms of comorbid illnesses may summate synergistically; comorbidities hinder management, negatively influencing outcomes; high-level comorbidity indicates that, where one disease occurs, the other should be looked for. The Eurolight project gathered population-based data on these disorders from 6624 participants.

          Methods

          Eurolight was a cross-sectional survey sampling from the adult populations (18–65 years) of 10 EU countries. We used data from six. The questionnaire included headache-diagnostic questions based on ICHD-II, the Headache-Attributed Lost Time (HALT) questionnaire, and HADS for depression and anxiety. We estimated odds ratios (ORs) to show associations between migraine, tension-type headache (TTH) or probable medication-overuse headache (pMOH) and depression or anxiety.

          Results

          pMOH was most strongly associated with both psychiatric disorders: for depression, ORs ( vs no headache) were 5.5 [2.2–13.5] ( p < 0.0001) in males, 5.5 [2.9–10.5] ( p < 0.0001) in females; for anxiety, ORs were 10.4 [4.9–21.8] ( p < 0.0001) and 7.1 [4.5–11.2] ( p < 0.0001). Migraine was also associated with both: for depression, ORs were 2.1 [1.3–3.4] ( p = 0.002) and 1.8 [1.1–3.1] ( p = 0.030); for anxiety 4.2 [2.8–6.3] ( p < 0.0001) and 2.4 [1.7–3.4] ( p < 0.0001). TTH showed associations only with anxiety: ORs 2.5 [1.7–3.7] ( p < 0.0001) for males, 1.5 [1.1–2.1] ( p = 0.021) for females. Participants with migraine carried 19.1 % probability of comorbid anxiety, 6.9 % of depression and 5.1 % of both, higher than the representative general-population sample (14.3, 5.6 and 3.8 %). Probabilities in those with MOH were 38.8, 16.9 and 14.4 %; in TTH, they did not exceed those of the whole sample. Comorbid psychiatric disorder did not add to headache-attributed productive time losses, but weak associations existed ( R 2  = 0.020–0.082) for all headache types between lost productive time and probabilities of depression and, less so, anxiety.

          Conclusion

          In this large study we confirmed that depression and especially anxiety are comorbid more than by chance with migraine, and showed the same is true, but more strongly, with MOH. Arguably, migraine patients and, more certainly, MOH patients should be screened with HADS in pursuit of best outcomes.

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          Most cited references29

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          The International Classification of Headache Disorders: 2nd edition.

          (2004)
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            The global burden of headache: a documentation of headache prevalence and disability worldwide.

            This study, which is a part of the initiative 'Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide', assesses and presents all existing evidence of the world prevalence and burden of headache disorders. Population-based studies applying International Headache Society criteria for migraine and tension-type headache, and also studies on headache in general and 'chronic daily headache', have been included. Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. Our calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women.
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              The impact of headache in Europe: principal results of the Eurolight project

              Background European data, at least from Western Europe, are relatively good on migraine prevalence but less sound for tension-type headache (TTH) and medication-overuse headache (MOH). Evidence on impact of headache disorders is very limited. Eurolight was a data-gathering exercise primarily to inform health policy in the European Union (EU). This manuscript reports personal impact. Methods The study was cross-sectional with modified cluster sampling. Surveys were conducted by structured questionnaire, including diagnostic questions based on ICHD-II and various measures of impact, and are reported from Austria, France, Germany, Italy, Lithuania, Luxembourg, Netherlands, Spain and United Kingdom. Different methods of sampling were used in each. The full methodology is described elsewhere. Results Questionnaires were analysed from 8,271 participants (58% female, mean age 43.4 y). Participation-rates, where calculable, varied from 10.6% to 58.8%. Moderate interest-bias was detected. Unadjusted lifetime prevalence of any headache was 91.3%. Gender-adjusted 1-year prevalences were: any headache 78.6%; migraine 35.3%; TTH 38.2%, headache on ≥15 d/mo 7.2%; probable MOH 3.1%. Personal impact was high, and included ictal symptom burden, interictal burden, cumulative burden and impact on others (partners and children). There was a general gradient of probable MOH > migraine > TTH, and most measures indicated higher impact among females. Lost useful time was substantial: 17.7% of males and 28.0% of females with migraine lost >10% of days; 44.7% of males and 53.7% of females with probable MOH lost >20%. Conclusions The common headache disorders have very high personal impact in the EU, with important implications for health policy.
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                Author and article information

                Contributors
                t.steiner@imperial.ac.uk
                Journal
                J Headache Pain
                J Headache Pain
                The Journal of Headache and Pain
                Springer Milan (Milan )
                1129-2369
                1129-2377
                1 June 2016
                1 June 2016
                2016
                : 17
                : 59
                Affiliations
                [ ]Headache Medical Center, Linz, Austria
                [ ]Department of Neurogeriatric Medicine and Remobilisation, Hospital of the Sisters of Charity, Linz, Austria
                [ ]Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, Norway
                [ ]Headache Science Centre, C Mondino National Neurological Institute, Pavia, Italy
                [ ]Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
                [ ]Department of Neurology, University of Duisberg-Essen, Essen, Germany
                [ ]Department of Neurology, Evangelical Hospital Unna, Unna, Germany
                [ ]Department of Neurology, Hospital Clinico Universitario, University of Valencia, Valencia, Spain
                [ ]Departement d’Evaluation et Traitement de la Douleur, Centre Hospitalo-Universitaire de Nice, Nice, France
                [ ]INSERM/UdA, U1107, Neuro-Dol, Clermont-Ferrand, France
                [ ]Lithuanian University of Health Sciences, Kaunas, Lithuania
                [ ]Asociacion Española de Pacientes con Cefalea (AEPAC), Valencia, Spain
                [ ]Norwegian Advisory Unit on Headache, St Olavs University Hospital, Trondheim, Norway
                [ ]Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
                [ ]Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
                [ ]Division of Brain Sciences, Imperial College London, London, UK
                Article
                649
                10.1186/s10194-016-0649-2
                4887397
                27245683
                ace38f4f-d636-4aae-9fdf-3b3074c96e4e
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 10 March 2016
                : 25 May 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Anesthesiology & Pain management
                headache,migraine,tension-type headache,medication-overuse headache,depression,anxiety,comorbidity,associations,public health,europe,eurolight project,global campaign against headache

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