Psychiatric Comorbidities and Environmental Triggers in Patients with Chronic Daily Headache: A Lifestyle Study

Objective: Patients with chronic daily headache (CDH) suffer from several significant psychiatric comorbidities and have unhealthy lifestyle. We aimed at studying psychiatric comorbidities, environmental triggers, lifestyle factors, and intensity of CDH in patients referred by the department of neurology from 2011 to 2014. Method: Through medical and psychiatric interviews and using 0 to 10 visual analogue scale (VAS), we assessed patients with CDH, using a checklist, to elicit psychiatric comorbidities, intensity of CDH, environmental factors, and lifestyle derangement. Results: We interviewed 413 (age 16-80 years, mean 40 +/- 14.0) out of 548 patients; 312 (75.5%) were married, and 282 (68.1%) were female. Environmental triggers (374, 90.6%) were the most common cause of CDH, while 214 (51.8%) had no compliance to recommended nutrition. Exercise avoidance (201, 48.7%) was the less prevalent lifestyle factor. Of the patients, 372 (90.1%) were stressed and 162 (39.2%) had obsessive-compulsive disorder (OCD), which were the most and less prevalent psychiatric comorbidities, respectively. Intensity of pain was moderate to severe (mean score = 7.1+/- 1.9), while females reported higher VAS scores (p<0.02). Patients with previous history of psychotherapy reported higher score of VAS (p<0.001). Those patients living with a person suffering from head pain reported more VAS score (p<0.003). Conclusion: Notable psychiatric comorbidities were found in patients with CDH, many of which are modifiable such as environmental triggers and unhealthy lifestyle. In heavily populated cities, these factors may double the burden of the CDH by precipitating new or exacerbating previous psychiatric comorbidities. We, thus, suggest conducting more studies on this subject.