title: Association of psychiatric co-morbidity and efficacy of treatment in chronic daily headache in Indian population.
abstract: OBJECTIVE
  To study the prevalence of psychiatric co-morbidity in patients of chronic daily headache (CDH) and compare the efficacy of treatment between various type of headache associated with psychiatric co-morbidity.
  
  
  METHODS
  Prospective case control cohort study, 92 consecutive patients of CDH meeting eligibility criteria. The diagnosis of various subtypes of CDH was made according to the IHS criteria. Age, sex, educational, marital and socioeconomic status, matched controls were also selected. Patients were evaluated with the Mini International Neuropsychiatric Interview (MINI) scale at the time of enrolment and at 3 months.
  
  
  RESULTS
  CDH accounted for 28% of all headache patients. The mean age of presentation was 30.2 ± 10.3 years, male: Female ratio of 28:64 and mean duration of 4.56 ± 0.56 years. Chronic migraine (CM) accounted for 59 patients, chronic tension type headache (CTTH) 22 patients, new daily persistent headache (NDPH) 3 patients and miscellaneous 8 patients. Psychiatric co-morbidity was present in 53.3% patients with CDH, and was more common in CM (62.7%) as compared to CTTH (36.4%). Single psychiatric co-morbidity was seen in 26 patients, while 23 patients had multiple co-morbidity. Major depressive episode, anxiety disorder, agoraphobia and dysthymia were significant psychiatric co-morbidities. Patients with CM were treated with topiramate or divalproex sodium ER and CTTH were treated with amitriptyline. 55 patients came for follow up at 3 months, improvement in headache was seen in 29 patients.
  
  
  CONCLUSIONS
  Psychiatric co-morbidity was present in more than 50% patients with CDH and its presence along with a duration of ≥2 years was associated with a poor response to treatment.
authors.affiliation: Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, Uttar Pradesh, India.
authors.forename: Ajai Kumar
authors.initials: AK
authors.lastname: Singh
authors.forename: Rakesh
authors.initials: R
authors.lastname: Shukla
authors.forename: Jitendra Kumar
authors.initials: JK
authors.lastname: Trivedi
authors.forename: Deepti
authors.initials: D
authors.lastname: Singh
keywords: Chronic daily headache; chronic migraine; chronic tension type headache; psychiatric co-morbidity
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