Greater frequency of depression associated with chronic primary headaches than chronic post-traumatic headaches.
OBJECTIVE
To compare the prevalence of co-morbid depression between patients with chronic primary headache syndromes and chronic posttraumatic headaches.


METHODS
A prospective cross-sectional analysis of all patients presenting sequentially to a community-based general neurology clinic during a 2-year period for evaluation of chronic headache pain was conducted. Headache diagnosis was determined according to the International Headache Society's Headache Classification criteria. Depression was determined through a combination of scores on the clinician administered Hamilton Rating Scale for Depression and patients' self-report. An additional group of patients who suffered traumatic brain injuries (TBI) but did not develop post-traumatic headaches was included for comparison.


RESULTS
A total of 83 patients were included in the study: 45 with chronic primary headaches (24 with chronic migraine headaches, 21 with chronic tension headaches), 24 with chronic post-traumatic headaches, and 14 with TBI but no headaches. Depression occurred less frequently among those with chronic post-traumatic headaches (33.3%) compared to those with chronic migraine (66.7%) and chronic tension (52.4%) headaches (Chi-Square = 7.68; df = 3; p = 0.053), and did not significantly differ from TBI patients without headaches. A multivariate logistic regression model using depression as the outcome variable and including headache diagnosis, gender, ethnicity, and alcohol and illicit substance use was statistically significant (Chi-Square = 27.201; df = 10; p < 0.01) and identified primary headache (migraine and tension) diagnoses (Score = 7.349; df = 1; p = 0.04) and female gender (Score = 15.281; df = 1; p < 0.01) as significant predictor variables. The overall model accurately predicted presence of co-morbid depression in 74.7% of the cases.


CONCLUSIONS
Co-morbid depression occurs less frequently among patients with chronic post-traumatic headaches and TBI without headaches than among those with chronic primary headaches.
University of California Los Angeles, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance. 90509, USA. amcmurtray@mednet.ucla.edu
Aaron M
AM
McMurtray
Erin K
EK
Saito
Natalie
N
Diaz
Bijal
B
Mehta
Beau
B
Nakamoto
D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology*; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D051270:Headache Disorders, Primary / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000453:epidemiology; D051298:Post-Traumatic Headache / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012737:Sex Factors; D018781:Tension-Type Headache / Q000175:diagnosis / Q000453:epidemiology; D013997:Time Factors