title: Precipitating or aggravating factors for headache in patients with major depressive disorder.
abstract: OBJECTIVE
  The aim of this study was to investigate the common precipitating or aggravating factors for headache among patients with major depressive disorder (MDD) and to compare precipitating or aggravating factors specifically for migraine with those for other headaches.
  
  
  METHODS
  Consecutive psychiatric outpatients with MDD in a medical center were enrolled. Headaches were diagnosed based on the International Classification of Headache Disorders, 2nd Edition. A 21-item self-report questionnaire was used to identify precipitating or aggravating factors. Subjects were divided into migraine and other-headache groups.
  
  
  RESULTS
  Of 122 subjects (76% female) with headache, 63 (51.6%) were diagnosed with migraine. Mental stress and depressive symptoms were the most common precipitating or aggravating factors, and 17 factors affected >50% of the subjects. Compared with other-headache groups, the migraine group was more sensitive to emotional and perceptional stimuli and to the stress of daily activities.
  
  
  CONCLUSIONS
  Treatment of depression and education of depressed patients about how to cope with mental stress might help to eliminate the negative impact of headache.
authors.affiliation: Department of Psychiatry, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
authors.forename: Ching-I
authors.initials: CI
authors.lastname: Hung
authors.forename: Chia-Yih
authors.initials: CY
authors.lastname: Liu
authors.forename: Shuu-Jiun
authors.initials: SJ
authors.lastname: Wang
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003710:Demography; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006261:Headache / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology*; D006801:Humans; D008297:Male; D010507:Periodicity; D015995:Prevalence; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires