Psychiatric Comorbidities Associated with Headaches: the Experience of the Liaison Consultation

Vera Martins, José Temótio, Ilda Murta

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.

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