title: Impact of depression and anxiety on burden and management of episodic and chronic headaches - a cross-sectional multicentre study in eight Austrian headache centres.
abstract: BACKGROUND
  Recurrent and especially chronic headaches are associated with psychiatric comorbidities such as depression and anxiety. Only few studies examined the impact of depression and anxiety on episodic (EH) and chronic headache (CH), and data for Austria are missing at all. Therefore, the aim of the present study was to assess the impact of depression and anxiety on burden and management of EH and CH in patients from eight Austrian headache centres.
  
  
  METHODS
  We included 392 patients (84.1 % female, mean age 40.4 ± 14.0 years) who completed the Eurolight questionnaire. The treating physician recorded details about ever-before prophylactic medications. We used Hospital Anxiety and Depression Scale to assess depression and anxiety and compared patients with anxiety and/or depression to those without.
  
  
  RESULTS
  Depression and anxiety were more common in CH than in EH (64 % vs. 41 %, p < 0.0001). Presence compared to absence of depression and anxiety increased the prevalence of poor or very poor quality of life from 0.7 % to 13.1 % in EH and from 3.6 % to 40.3 % in CH (p = 0.001; p < 0.0001). Depression and anxiety had a statistically significant impact on employment status and on variables related to the burden of headache such as reduced earnings, being less successful in career, or feeling less understood. Neither in EH nor in CH health care use and the ever-before use of prophylactic medication was correlated with anxiety and/or depression.
  
  
  CONCLUSIONS
  Depression and anxiety have a significant impact on quality of life and increase the burden in patients with EH and CH. Improved multidimensional treatment approaches are necessary to decrease disability on the personal, social and occupational level in these patients.
authors.affiliation: Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. karin.zebenholzer@meduniwien.ac.at.
authors.forename: Karin
authors.initials: K
authors.lastname: Zebenholzer
authors.affiliation: Department of Neurology, Medical University of Graz, Graz, Austria. anita.lechner@klinikum-graz.at.
authors.forename: Anita
authors.initials: A
authors.lastname: Lechner
authors.affiliation: Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria. gregor.broessner@i-med.ac.at.
authors.forename: Gregor
authors.initials: G
authors.lastname: Broessner
authors.affiliation: Headache Centre Seilerstätte, Hospital Sisters of Charity Linz, Linz, Austria. christian.lampl@bhs.at.
authors.forename: Christian
authors.initials: C
authors.lastname: Lampl
authors.affiliation: University Clinic of Neurology, Christian-Doppler-Klinik Salzburg, Salzburg, Austria. g.luthringshausen@salk.at.
authors.forename: Gernot
authors.initials: G
authors.lastname: Luthringshausen
authors.affiliation: Neurological Office Vienna, Vienna, Austria. albertwuschitz@gmx.de.
authors.forename: Albert
authors.initials: A
authors.lastname: Wuschitz
authors.affiliation: Department of Neurology, Klinikum Klagenfurt, Klagenfurt, Austria. sonja-maria.obmann@kabeg.at.
authors.forename: Sonja-Maria
authors.initials: SM
authors.lastname: Obmann
authors.affiliation: Department of Neurology, aö. BKH Kufstein, Kufstein, Austria. klaus.berek@bkh-kufstein.at.
authors.forename: Klaus
authors.initials: K
authors.lastname: Berek
authors.affiliation: Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. christian.woeber@meduniwien.ac.at.
authors.forename: Christian
authors.initials: C
authors.lastname: Wöber
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D001317:Austria / Q000453:epidemiology; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006261:Headache / Q000453:epidemiology*; D020773:Headache Disorders / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life
keywords: Anxiety; Burden; Chronic headache; Depression; Episodic headache; Medication overuse headache; Migraine; Psychiatric comorbidity; Quality of life; Tension-type headache