Psychological characteristics in chronic headache patients and their influences on therapeutic outcome

J Korean Neurol Assoc > Volume 15(4); 1997 > Article

Journal of the Korean Neurological Association 1997;15(4): 847-857.

만성 두통 환자의 심리적 특성과 치료 효과에 대한 영향

연세대학교 의대 신경과

Psychological characteristics in chronic headache patients and their influences on therapeutic outcome

Young Ho Sohn, MD

Department of Neurology and Brain Research Institute, Yonsei University College of Medicine

Abstract

Headache is one of the meet common symptoms in neurological outpatient clinic. It is not so easy for physicians and neurologists to manage headache, especially if it is chronic although it seldom causes serious problem. There are many psychological factors known to induce, maintain and aggravate symptom in patients with chronic headache. Thus it is necessary to identify these factors in each patient when planning therapeutic strategies. In order to assess the influence of psychological characteristics, such as depression, anxiety and stress, on therapeutic outcome in patients with chronic headache, I performed Beck depression inventory (BDI), General assessment of recent stress scale (GARS) and State-trait Anxiety inventory (STAI) in 13 patients with migraine, 14 with tension-type headache and 29 with unclassified headache, meet of whom are with mixed or chronic daily headache. In all patients the duration of headache is more than one year. The effect of therapy (flunarizine + amitriptyline or moclobemide) was assessed using self-rating headache index after three months. Patients in unclassified g개up were significantly older and had longer duration of symptoms than other groups. While GARS and STAI scores were comparable among groups, the BDI score in unclassified group was significantly higher than other groups. The therapeutic response was relatively poor in patients in unclassified group and patients with long-term analgesics abuse, compared with other groups. The poor responders to therapy showed higher BDI and STAI more than moderate as well as good responders. Sbepwise regression analysis was performed to exclude interactions between psychological characteristic, and it revealed depression is the strongest variable influencing therapeutic outcome. These results suggest; first, there are no significant differences in psychological characteristics between migraine and tension-type headache; second, patients with depressive trait are prone to have chronic daily headache; third, among the psycholog