Introduction
Headache as well as being sad is a feeling that is perceived by all of us at a certain moment of time and will have no effect on our body if it comes and goes but it would be very dangerous if it stays for a longer duration of time. Various factors played a role and involvement of multiple factors were reported like genetic, chemical, biological and environmental.1 Therefore it is extremely important to deal with actuality of emotions that were related to a disease. 2 Co-existence of both headache and migraine as a comorbidity will definitely results in decline in the prognosis, genes also played a role in disorders like headache, anxiety, depression, they all shares a common core feature of tendency to be repeatable. 3 Fluctuations in mood and pain both are inter connected to each other in various ways.4 There is a presence of coexisting boundaries between certain symptoms of low mood, inappropriate sleep pattern, headache, persistent gastritis as well as panic attack.5 More than 80% of patients with migraine co morbidly suffers from depression also.6 In order to establish the relationship between the role of headache in depression studies are done both is retrospective as well as prospective directions in terms of burden of expenses on health.7 A broad variability in mood is shown in headache, a proper calm mind can all of a sudden react angrily along with crying spells due to unbearable pain. 8 Persistent complaint of headache, body ache, nausea, vomiting will slowly get converted into major depressive disorder. 9 Prognostic factors for chronic headache are also very important in understanding the prognosis of depression. 10 Depression is a persistent low mood that affects the entire routine of a person even without affecting the external appearance of that person. 11 Studies shows that it is very important to understand the actual pathology and physiology behind depression from the role of monoamines and other neurogenic factors. 12 Headache specific to migraine presented with nausea, vomiting, giddiness and intolerance to loud noise and bright light. 13 Pain as a first identity of somatic complaint is found to be a common finding in Depression, Cognitive behaviour therapy also plays a good role in treatment along with medications. 14 A person suffering from migraine will have various complaints of psychological imbalance where we can found that the symptoms depression were also found frequently in them. 15 Treatment of patients that includes relief and subsides the symptoms with medicines that includes antidepressants, mood stabilizers, benzodiazepines along with NSAIDS, antacids and antiemetic’s. Use of certain medicines and relief in the symptoms indicates towards the role of Depression in patients 16 which is in the form of multiple somatic complaints that includes low mood, inappropriate sleep, aggression, irritability along with Headache and an overall impairment in the performance of an individual which overall lowers the productive work efficacy of an individual. It is seen very prominently reported in previously done studies that headache is found frequently in patients with Depression. The level of extents of Headache is actually far beyond other non-communicable disorder ,low back pain is also a most frequently reported complaint along with headache as a comorbidity in patients with Depression. 17 Experiencing headache is quite a frequent complaint and it is very necessary to get it known that whether it is a primary headache or a secondary headache with having a possibility of comordity with other disorders also, and that is evaluated by taking a proper history along with the clinical and pathological examination regarding the mode of onset(early or late)(acute or chronic), intensity (mild, moderate or severe) ,duration(lasting for a shorter duration or longer lasting)(chronic and persistent) of headache and coincides with low mood decrease sleep, decrease appetite body ache.18 Studies done previously proven the role of cognitive behaviour therapy in treatment of patients consulting in out patient department for Headache with comorbid psychological disturbances and symptoms of depressive disorder, other techniques like biofeedback, relaxation of mind ,yoga orientation were also broadly used in headache due to depression along with anti-depressive medications. 19 Regularly an up gradation and modification in treatment protocols is a challenging task for practitioners but still they were continuously taking an effort to get it done for the best of their patients which should include all sort of effective treatment and therapies by considering the sign and symptoms very sharply. 20 Major symptoms of Depression were associated with the impairment of proper functioning of a person socially, mentally and occupationally which affects the mental well being of an individual that cause Depression along with secondary impairment in functional activities. 21 Depression is very commonly found along with anxiety and panic attacks in patients complaining for headache and it also contributes to financial burden on the patient. 22, 23 Migraine affects the maximum portion of population still there is a question mark that the mechanism of migraine is not very well understood because of its role in terms of affecting in various ways in clinical, biological and genetic and that needs to be elaborated and illustrated to be more understood. 24 Migraine is found very frequently with tension types headaches in adolescent age group who are more prone to be involved in stressed out behaviour. 25, 26 Tension and headache are most commonly found in people who worked for prolong hours and sitting throughout several nights sleeplessly The existence of low mood and panic attack leads to migraine very commonly but the role of age differences along with gender is still need to be explored. 27
Aim
Aim of this study is to assess the Depression in patients presenting an outpatient department of Psychiatry specifically for treatment of headache.
Materials and Methods
Results
A cross sectional study done at outpatient department of Psychiatric OPD of Maharishi Devraha Baba Autonomous State Medical College DEORIA including a number of 100 patients. The results were depicted in the tables shown below:
Table 1
Socio demographic profile of the patients
Table 1 shows the data of the demographic and social standard of the patients included in our study, our study had included 40% of male patients and 60% of female patients, 65% of the patients included in this study were married whereas 35% of them were unmarried, 50% of the patients involved in this study were belonged to Hindu families and rest of the 50% belongs to Non-Hindu families,70% of the patients were employed whereas rest of the 30% belongs to unemployed strata, 40%of the patients involved in our study belongs to a lower socioeconomic status whereas 60% of the patients belongs to middle socioeconomic status.25% of the patients belongs to rural background whereas 75% of the patients belongs to urban background.
Table 2
Shows results of beck depression inventory applied in all patients taken in the study.
|
|
Normal |
Mild |
Borderline |
Moderate |
Severe |
Extreme |
|
% of patients |
Nil |
10% |
12% |
70% |
8% |
Nil |
|
Mean SD |
- |
13.8 ±1.72 |
18.33 ± 1.8 |
25.66 ± 2.45 |
33.1± 3.1 |
- |
Table 2 Shows the results of Beck Depression Inventory (BDI) in patients taken in this study. It is scale which includes a certain amount of questions which depicts us the status of variability in the mood of a person. Most of the patients in our study admitted here a state of low mood while perceiving a feeling of Headache. None of the patient in this study is reported to have no complaints of low mood or never experienced to be feeling low, 10%of the patients here shows a mild state of Depression,12% of patients have shown a state of borderline fluctuation in their depressive state,whereas70% of the patients have shown a moderate state of depression which is a big portion of the study subjects, while 8% of the patients were in a very severe state of Depressive episode, whereas none of the patient reported to have a condition of extreme level of depression.
Table 3
Shows the scoring of patients on Headache Impact test
|
|
Normal |
Mild |
Moderate |
severe |
Extreme |
|
% of patients |
Nil |
15% |
38% |
40% |
7% |
|
Mean SD |
- |
45.8 ± +1.5 |
57.13 ± 3.08 |
70.9 ± 3.25 |
76.75 ± 0.82 |
Table 3 Shows the extent to which patients perceive Headache that make them visit an outpatient department of psychiatry when Headache Impact Test in the form of a questionnaire was applied where 15% of the patients presented with mild headache, 38% of patients were presented with moderate headache, 40% of the patients were presented with severe headache and 7% were presented with extreme headache.
Table 4
Shows clinical history
|
Variables |
Range |
Mean ± SD |
|
Onset (In years) |
35 |
23.27 ± 6.77 |
|
Duration of illness (In years) |
11 |
4.98 ± 2.8 |
Table 4 Shows Clinical history of the patients, where 18 to 45 years of of patients were involved in this study. The age of onset of symptoms (in years) lies in the range of 35 whereas the duration of illness of disease (in years) lies in the range of 11.
Table 5
Shows the treatment given to the patients involved in this study.
o.5Shows the treatment given to the patients involved in this study which includes the treatment of low mood with episodes of depression in patients attending the outpatient department for the complaint of Headache. 60%of the patients were on selective serotonin reuptake inhibitor whereas 20% were kept on serotonin modulator and stimulator, both of them were added for complaints of low mood and depression, 80%of the patients were given mood stabilizers for fluctuations and variability in their mood during the whole day with frequent episodes of crying without any specific reason with excessive anger outburst along with persistent irritable behaviour. 100%of the patients in the study were given NSAIDs for Headache, along with antiemetic and antacids for preventing gastric comfort caused by the medicine or due to severe episodes of Headache.
Discussion
15% of the patients in this study presented with mild grade of headache, 38% presented with moderate grade of headache, 40% of the patients presented with severe grade of headache, whereas 7% of the patients presented with an extreme grade of headache on headache impact test.
When Beck Depression inventory was applied in these similar patients 5% of these patients presented with symptoms of depression, 12% of these patients were presented with symptoms of borderline depression. 70% of the patients were presented with symptoms of moderate depression, whereas 8% of the patients presented with severe symptoms of depression, none of the patients fulfils the criteria for extreme grade of depression in this study.
Conclusion
This study is done to understand the importance of properly analysing a case before making an appropriate diagnosis. Depression is a psychiatric disorder which can be very easily recognized by proper listening to the chief presenting complaints of the patient in order to prevent misdiagnosing a case. Headache is the first and foremost indicator for the long time underlying symptoms of Depression.
