Headache and psychiatry

What is a headache?
A headache is a non-specific symptom that has a major impact on the quality of life of the sufferer. It is not possible to make a diagnosis only on the basis of headaches as a symptom.

What are the causes of headaches?
There can be many reasons for a headache. For example, it can have systemic reasons like anaemia, or it can be the result of localised problems in the head-neck region. It can also be of psychical origin. The most common type of headache is migraine. Other common types of headaches are tension headaches and cluster headaches.

When we are dealing with headaches, physical and psychological problems are closely linked, in other words we cannot say that one is the cause of the other. There is a two-way interaction between them driven by the same mechanism. A typical example for this is depression. Both migraine and depression result from the same neurotransmitter mechanisms. This explains why we often see depression in people suffering from migraine, and migraine in people with depression.

Which psychological disorders are accompanied by headaches?
Depression, bipolar disorder, general anxiety disorder, panic and obsessive compulsive disorders are often accompanied by headaches. Apart from the Axis 1 disorders, headaches are also common in Group B disorders which include Sxis 2 personality disorders (Narcissistic personality disorder, borderline personality disorder and antisocial personality disorder).

Why do we get recurrent headaches?
There are many factors that play a role in headaches becoming chronic. Amongst the primary ones are obesity, sleep disorders, excessive and unsupervised drug intake for headaches, irregular eating habits. We also have signs that point at a possible role played by certain psychological factors, for instance perfectionism, inability to express anger, other psychiatric disorders.

Is there a link between lack of sleep and headaches?
There is definitely a close link between them. Snoring, sleep apnoea, insomnia in the form of insufficient sleep or difficulties in falling asleep and staying asleep, morning fatigue are all factors that can trigger headaches.

Do headaches have an EEG function?
Headaches occur in some types of epilepsy, therefore we can use EEG to eliminate that likelihood. Again some researchers emphasize that in migraine related pain the EEG shows a slowing down of ground activities. This suggests that EEG can be a useful technology in migraine. Headaches are a dynamic process. Their severity, frequency and type can change at any moment. It is therefore advisable that the patient is under a doctor’s regular supervision and treatment is adjusted in parallel to the dynamic changes that occur.

The importance of family history in headache cases
Some headaches have a genetic side. Family history is also valuable in establishing the patient’s socio-economic level. As you know, the lower the socio-economic level, the higher the likelihood of coming across headache cases.

The main difference between tension type headaches and other headaches
Tension headaches are triggered by anxiety and generally follow a chronic course. This is the group that most benefits from relaxation techniques.

When does a headache become chronic?
As mentioned above, headaches becoming chronic is associated with obesity, uncontrolled drug use, psychiatric findings and similar. Therefore it is important that in any headache case these factors are dealt with.

Substance abuse as a cause of headaches
Substance abuse, the use of high dosages and withdrawals are amongst the causes of severe headaches. I am not talking about a specific substance, it can be cigarettes, alcohol, opiates etc, all of these …

Psychiatry and the benefits of a neurological approach
Headaches come under the shared area of interest of psychiatry, neurology and algology. When we take into considering how frequently we encounter excessive use of medication, obesity, sleep disorders, depression, anxiety, bipolarity and personality disorders, it becomes clear that a headache polyclinic without psychiatry will most certainly be unsuccessful. A headache polyclinic without neurology would be unable to make a distinctive diagnosis, and algology, as a medical discipline that deals with the finer mechanisms of every type of pain, most definitely has to take its place in this process.

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