Psychiatric Comorbidity Outweighs Headache Subtype As A Predictor Of Disability In Chronic Daily Headache: A...

Objective: Chronic daily headache (CDH) is a prevalent neuropsychiatric condition. We aimed to quantify concurrent Axis I psychiatric comorbidity and personality pathology in CDH versus matched controls and identify factors independently associated with headache-related disability.

This hospital-based matched-control study was conducted at a tertiary teaching hospital in Faridabad (Delhi-NCR), India. Seventy-five ICHD-3-confirmed CDH patients and 75 age- and sex-matched controls completed the Mini International Neuropsychiatric Interview (MINI v5.0), Millon Clinical Multiaxial Inventory-III (MCMI-III; personality, base rate ≥ 85), and Headache Impact Test-6 (HIT-6). Multivariable binary logistic regression identified independent cross-sectional associates of high disability (HIT-6 ≥ 56). STROBE guidelines were followed.

Psychiatric comorbidity was present in 60.0% of cases versus 13.3% of controls (χ² = 33.19, p < .001, V = 0.47), predominantly depression (33.3%) and anxiety (28.0%). Personality disorders occurred in 56.0% versus 18.7% (χ² = 22.27, p < .001, V = 0.39). An exploratory Cluster A signal was observed for paranoid (10.7% vs. 0%, p = .006) and schizoid (10.7% vs. 1.3%, p = .034) pathology; small cells render these findings hypothesis-generating. Psychiatric comorbidity was the strongest independent associate of high disability (adjusted OR=10.82, 95% CI 3.03-38.60, p < .001), exceeding migraine subtype (OR=5.12, p = .037). Personality disorder showed a non-significant trend (OR=3.30, p = .066; Nagelkerke R² = 0.482).

Psychiatric comorbidity was strongly and independently associated with disability in CDH, supporting integrated psychiatric screening. The exploratory Cluster A signal warrants replication in adequately powered prospective studies.