Headache psychiatry: A structured narrative review and integrative framework.

Area of Science:

• Neuroscience
• Psychiatry
• Pain Medicine

Background:

• Headache disorders are influenced by neurobiological, psychiatric, behavioral, and social factors.
• Psychiatric comorbidity and psychosocial factors are not well-integrated into current headache care models.
• A unified framework is needed to bridge the gap between headache and psychiatric research and practice.

Purpose of the Study:

• To synthesize evidence linking psychiatric factors with headache disorders.
• To propose Headache Psychiatry, operationalized by the Psychocephalology model, as an integrative framework.
• To highlight the need for a biopsychosocial approach in managing headache disorders.

Main Methods:

• Structured narrative review of literature from PubMed, PsycINFO, and Web of Science (1990-2025).
• Examination of psychiatric comorbidity, emotion regulation, stress physiology, pain neuroscience, and psychosocial determinants.
• Synthesis of findings within the five domains of the Psychocephalology framework.

Main Results:

• Strong bidirectional associations found between headache and depression, anxiety, trauma, and sleep disturbance.
• Emotion dysregulation, catastrophizing, and poor coping predict headache chronification and disability.
• Heightened activity in neural pain-emotion circuits observed in chronic migraine; HPA axis dysregulation linked to chronic headache.

Conclusions:

• Headache Psychiatry, via the Psychocephalology framework, provides a unified biopsychosocial model.
• Clinical implementation requires psychiatric screening, multidisciplinary teams, and integrated treatments.
• This integrative approach allows for personalized, context-sensitive care, potentially preventing headache chronification.