title: Depression and anxiety in episodic and chronic cluster headache: a pilot study.
abstract: BACKGROUND
  In contrast to migraine and tension-type headache, the psychiatric comorbidities of cluster headache (CH) have not been well-studied.
  
  
  OBJECTIVE
  We assessed the presence of depression and anxiety in groups of episodic CH (ECH) and chronic CH (CCH) patients and compared CH patients with and without depression and anxiety.
  
  
  METHODS
  Sociodemographics, comorbidities, and selected headache features were ascertained from a clinic-based sample in a cross-sectional fashion from January 2007 to July 2010. Active depression and anxiety were assessed using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) scales.
  
  
  RESULTS
  Of 49 CH patients, ECH patients (n=32) had an earlier age of onset and consumed less caffeine than CCH patients (n=17). Rates of depression as defined by a PHQ-9 score ≥10 were low in both ECH (6.3%) and in CCH (11.8%) with similar mean PHQ-9 scores (3.1 vs 3.7, P=.69). Rates of anxiety as defined by a GAD-7 score ≥10 were also low in both ECH (15.6%) and CCH (11.8%) with similar mean GAD-7 scores (3.8 vs 3.4, P=.76). ECH patients in and out of active attack periods had similar levels of depression and anxiety. Depression and anxiety usually occurred together in ECH and CCH patients. CH patients who were depressed or anxious were more likely to present at a younger age and have attack-related nausea and prodromal symptoms. Depressed CH patients were also more likely to have another pain disorder and had undertaken twice as many prophylactic medication trials.
  
  
  CONCLUSIONS
  In this clinic-based cross-sectional study, ECH and CCH patients had similarly low rates of depression and anxiety. Rates were lower than those reported for both episodic and chronic migraine.
authors.affiliation: The Montefiore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. marobbin@montefiore.org
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Robbins
authors.forename: Rachel
authors.initials: R
authors.lastname: Bronheim
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
authors.forename: Brian M
authors.initials: BM
authors.lastname: Grosberg
authors.forename: Sarah
authors.initials: S
authors.lastname: Vollbracht
authors.forename: Fred D
authors.initials: FD
authors.lastname: Sheftell
authors.forename: Dawn C
authors.initials: DC
authors.lastname: Buse
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D002648:Child; D003027:Cluster Headache / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D055815:Young Adult