title: High prevalence of somatic symptoms and depression in women with disabling chronic headache.
abstract: OBJECTIVE
  To better define, in women with headache, the relationship of depression and somatic symptoms to headache, characterized by diagnoses, frequency, and disability.
  
  
  METHODS
  At six headache specialty clinics, women with headache were classified using ICHD-II criteria, and frequency was recorded. A questionnaire addressing demographics, age at onset of headache, headache-related disability, somatic symptom, and depression severity was completed. Logistic regression was performed to measure the associations of headache frequency and headache-related disability with somatic symptom and depression severity.
  
  
  RESULTS
  A total of 1,032 women with headache completed the survey, 593 with episodic (96% with migraine) and 439 with chronic headache (87% with migraine). Low education and household income was more common in chronic headache sufferers and in persons with severe headache disability. Somatic symptom prevalence and severity was greater in persons with chronic headache and with severe headache-related disability. Significant correlation was observed between PHQ-9 and PHQ-15 scores (r = 0.62). Chronic headache, severe disability, and high somatic symptom severity were associated with major depressive disorder (OR = 25.1, 95% CI: 10.9 to 57.9), and this relationship was stronger in the subgroup with a diagnosis of migraine (OR = 31.8, 95% CI: 12.9 to 78.5).
  
  
  CONCLUSIONS
  High somatic symptom severity is prevalent in women with chronic and severely disabling headaches. Synergistic relationship to major depression exists for high somatic symptom severity, chronic headache, and disabling headache, suggesting a psychobiological underpinning of these associations.
authors.affiliation: Department of Neurology, The University of Toledo-Health Science Campus, Toledo, OH 43614, USA. gtietjen@meduohio.edu
authors.forename: G E
authors.initials: GE
authors.lastname: Tietjen
authors.forename: J L
authors.initials: JL
authors.lastname: Brandes
authors.forename: K B
authors.initials: KB
authors.lastname: Digre
authors.forename: S
authors.initials: S
authors.lastname: Baggaley
authors.forename: V
authors.initials: V
authors.lastname: Martin
authors.forename: A
authors.initials: A
authors.lastname: Recober
authors.forename: L O
authors.initials: LO
authors.lastname: Geweke
authors.forename: F
authors.initials: F
authors.lastname: Hafeez
authors.forename: S K
authors.initials: SK
authors.lastname: Aurora
authors.forename: N A
authors.initials: NA
authors.lastname: Herial
authors.forename: C
authors.initials: C
authors.lastname: Utley
authors.forename: S A
authors.initials: SA
authors.lastname: Khuder
mesh_terms: D000203:Activities of Daily Living; D017677:Age Distribution; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D004185:Disability Evaluation; D004522:Educational Status; D004651:Employment; D005260:Female; D020773:Headache Disorders / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020886:Somatosensory Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology