[Therapeutic approaches to comorbid pathology in episodic migraine and tension-type headache]

To assess the severity of anxiety, depression, insomnia and asthenia in patients with episodic migraine and tension-type headache before and after treatment.

104 patients aged 18 to 74 years were examined. Patients were divided into two groups: the 1^st - 41 patients diagnosed with episodic migraine, the 2^nd - 63 patients with episodic tension-type headache. The intensity of headache was assessed using the visual analog scale (VAS). The Hospital Anxiety and Depression Scale (HADS), the Levin questionnaire, and the Multidimensional Fatigue Inventory scale (MFI-20) were used to identify comorbid affective pathology, insomnia, and asthenia, respectively.

Headache severity according to VAS in the 1^st group was higher (5.8±1.3 points) than in 2^nd (3.8±1.2 points). Clinical anxiety was detected in 66.3% of patients without statistically significant differences between groups. The mean HADS anxiety score was 13.9±3.5 in 1^st group, 12.7±3.7 - in 2^nd. Clinical depression was detected in 45.2% of patients, more often in the 2^nd group - 50.8% than in the 1^st (36.6%). The mean depression score according to HADS was 9.0±4.4 and 9.7±3.6 in the 1^st and 2^nd groups respectively. The intensity of headache was statistically significantly higher in patients with clinical anxiety. Both groups were found to have insomnia and asthenia. The majority of patients - 67.3% had myofascial pain syndrome. When re-evaluating the severity of disorders after treatment (using anxiolytics, antidepressants, muscle relaxants, magnesium and neurometabolics), a significant positive trend was noted. Reducing the intensity of headaches to 3.2±0.9 points (according to VAS scale) was in patients with migraine and 1.9±0.8 points in 2^nd group. Relief of anxiety and depressive disorders was observed (HADS) in 1^st (4.3±3.9) and 2^nd (4.5±3.3) groups, the severity of depression (HADS) - 2.1±2.2 in 1^st and 2.8±3.2 in 2^nd groups, as well as a decrease in asthenia and normalization of sleep. The decrease in the severity of asthenia during treatment was more significant in patients treated with Cytoflavin.

Identification and treatment of comorbid pathology leads to positive results in the treatment of primary headaches such as episodic migraine and TTH.