Relationship between headache types and severity with psychiatric comorbidity in adolescents

Headache is a prevalent health concern among children and adolescents, affecting approximately 54.4% of this population. It has a negative impact on functionality and is associated with psychiatric conditions. The aim of this study is to examine the prevalence and comorbidity of headache among adolescents seeking care at a child psychiatry outpatient clinic and to compare the psychiatric conditions of adolescents with and without headache by using specific assessment scales.

The study included a total of 306 patients (201 females, 105 males), comprising 108 adolescents with headache and 198 without headache, who were admitted to the Child&Adolescent Psychiatry Outpatient Clinic of a Mental and Nervous Diseas- es Training and Research Hospital. Patients presenting with complaints of headache were referred to the neurology department of the hospital for diagnosis and classification. The Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version-Turkish Adaptation was administered to all participants. Additional self-report scales including the State-Trait Anxiety Inventory (STAI) Forms 1 and 2, the Children's Depression Inventory (CDI), and the Young Internet Addiction Test - Short Form were given. Parents filled out the Conners' Parent Rating Scale and the Turgay DSM-IV-Based Child and Adolescent Disruptive Behavior Disorders Screening and Rating Scale.

Among participants, 35.3% (n=108) have reported headache, divided into two subgroups; 58 had migraine and 50 had tension-type headache. The prevalence of Generalized Anxiety Disorder as a comorbid diagnosis was found to be significantly higher in the migraine group compared to those without headache (p=0.009). Nevertheless, there was no difference between migraine and tension type headache groups in terms of comorbid psychiatric diagnoses (p>0,05). The participants in both headache groups exhibited significantly elevated scores on the CDI, STAI-1 and STAI-2 in comparison to those without headache (p < 0.001). A positive correlation was identified between headache severity and both depression and trait anxiety severity among participants with headache. When classified according to the course of headache, chronic migraine was associated with higher Turgay and Conners scores, while chronic tension-type headache showed significantly higher CDI, STAI-1, and STAI-2 scores compared to episodic forms (p = .003-.038).

Psychiatric comorbidities are common in adolescents with headache, necessitating a comprehensive assessment that considers both conditions. This approach is crucial, as it has the potential to significantly influence the diagnosis, severity, progression, and treatment of these comorbidities, thereby ensuring comprehensive care and superior outcomes for affected individuals.