#Richard markx greatist hight manual
Anxiety disorders are a separate category of psychiatric disorders in The Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR), which contains six major anxiety disorders, namely generalized anxiety disorder (GAD), panic disorder, specific phobias, social anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). This chapter describes the major anxiety disorders and their associations with headache, the increased burden of comorbid anxiety and headache, the mechanisms hypothesized to explain the connection between anxiety and headache, and the behavioral treatments and strategies for managing anxiety and headache. The prognosis is generally favorable, with limited disability during headache occurrences and age-related improvement or resolution of episodes later in life. Aspirin is more effective than placebo and comparable to the efficacy of acetaminophen in the relief of acute TTH. Simple analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), and combination agents are most commonly recommended. TTH is typically managed mainly through administration of medication during acute episodes.
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One recent study of psychiatric comorbidity in patients with migraine, TTH, and migraine plus TTH revealed significant differences in the rate of occurrence of depression, with the combined group being of highest risk.
The phenotypic features of TTH are non-specific and may be seen with an assortment of secondary headache conditions, which are linked mechanistically to an identifiable structural or physiological disorder. Tension-type headache (TTH) is the most common form of headache in the general population. The high rates of psychiatric comorbidity with migraine highlights the importance for healthcare professionals (HCPs) to maintain diagnostic vigilance and provide appropriate treatment or referrals when necessary. Rates of psychiatric comorbidity are even higher among persons with more frequent headache. Some psychiatric comorbidity, including depression and anxiety, has been associated with increasing migraine attack frequency, or progression from episodic to chronic migraine. Psychiatric comorbidities can influence the frequency and severity of migraine, and impact disease prognosis, treatment, and clinical outcomes. Unidirectional causal models suggest that an index disease increases the risk of the comorbid disorder. Patients with migraine and tension-type headache exhibit psychiatric illnesses at a disproportionately higher rate than individuals with no history of recurrent headache. Anxiety disorders have been found to be significantly associated with migraine in both clinical and community-based studies.
This chapter focuses on the psychiatric comorbidities of migraine and other headache disorders.
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