Association of panic disorder with quality of life among individuals with headache.

Introduction Headache is a common cause for medical consultation. (1) Tension-type headache (TTH) is the most common cause for primary headache (69%), followed by migraine headache (16%). (2) Headache often results in considerable disability and poor quality of life. (2) The present lifetime disability attributable to migraine of 0.5 in terms of disability-adjusted life years is equal to or more than that of several other major chronic illnesses such as hypertension, breast cancer, and rheumatoid arthritis. (1) Psychiatric illnesses are commonly associated with headache. The relationship of anxiety disorders and depression with migraine has been established in various studies. (3-5) Anxiety is the commonest co-morbidity affecting about 75% of patients (6); its association with migraine is stronger than that with depression, (3) and the presence of anxiety disorders is an independent risk factor for depression in patients with migraine. (4) Panic disorder and phobia are the most common anxiety diagnoses among migraineurs. (7) There is paucity of clinical literature concerning the association of anxiety disorders in relation to headache. At present, it is difficult to clinically distinguish migraine from TTH, as the International Headache Society's main definition of TTH allows an admixture of nausea, photophobia, or phonophobia in various combinations, although the appendix definition does not. (2) This illustrates the difficulty in distinguishing migraine from TTH. Migraine is associated with anxiety, depression, and poor quality of life. (2) To our best knowledge, there is no published evidence on the association of panic disorder with severity of anxiety symptoms among patients with headache. Thus, in the present study, we evaluated the prevalence of panic disorder among patients with headache, and the possible association of panic disorder with severity of anxiety symptoms and quality of life in the patients with headache. Methods A total of 100 consecutive patients of both genders between 18 and 60 years, and having headache as a presenting complaint for at least 3 months were recruited from the psychiatry outpatient department of a tertiary care hospital from April 2012 to July 2012. Patients with severe mental illnesses including schizophrenia, bipolar mood disorder, cognitive impairment, chronic disabling illnesses, negative symptoms, dementia, and poor attention, as well as those unable to give verbal replies were excluded from the study. Patients on antidepressant, antipsychotic or antianxiety medications in the last 2 months were also excluded. Causes for secondary headache involving organic aetiologies like systemic infection, head injury, vascular disorders, subarachnoid haemorrhage and brain tumours were ruled out with clinical examination. Participants were interviewed by the principal investigator on demographic variables like age, gender, residence, religion, marital status, education, socio-economical status, and tobacco use. Duration and characteristics of headache (dull aching, throbbing or mixed) were recorded. The visual analogue scale (VAS) was used for recording the severity of headache using self-rating on a scale of 0 to 10. (8) History and family history of headache or any other psychiatric consultation were recorded. Participants were interviewed for the symptoms of anxiety disorders like panic disorder, agoraphobia and for the diagnosis of panic disorder with agoraphobia (PA) and panic disorder without agoraphobia (PoA) using clinician-administered interview as per the DSM-IV-TR criteria. (9) The diagnosis was confirmed by a consultant psychiatrist holding a master degree in psychiatry and with more than 25 years of experience in the subject. Hamilton Anxiety Rating Scale (HAM-A), a 14-item observer-rated scale, was used to assess the severity of the anxiety symptoms. (10) The participants were asked to complete the 26-item World Health Organization Quality of Life Scale brief version (WHOQOL-BREF) which is a self-rating questionnaire for assessment of the quality of life in the domains of physical health, psychological health, social relationship, and environment. …