Comorbidity with Psychiatric Disorders

  • Marco A. Arruda
  • Noemi Faedda
  • Giulia Natalucci
  • Vincenzo GuidettiEmail author
Part of the Headache book series (HEAD)


Headache is one of the most frequently reported somatic complaints by children and adolescents [1], and it affects about 54.4% of children and adolescence in the world [2]. Tension-type headache (TTH) (prevalence of 20–25%) is the most common cause of primary headache, followed by migraine (prevalence of 8%) [3]. TTH and migraine were identified as second and third most common diseases all over the world [4], and furthermore they are associated with a great number of comorbidities such as anxiety, mood disorder, attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), etc. [5, 6]. Although some authors suggested that fundamental cause of migraine in children is largely genetic [7], Arruda et al. [8] showed in a large sample of Brazilian children that patients with migraine are at an increased risk of having emotional symptoms, conduct problems, hyperactivity, peer problems, and total difficulties in psychosocial adjustment. Children with ETTH, in turn, were significantly more likely to have emotional symptoms and total difficulties causing impact in their psychosocial adjustment compared with controls.


Headache Comorbidity Children Adolescents Psychiatric disorder Quality of life 


  1. 1.
    Casucci G, Terlizzi R, Cevoli S. Headache in school age. Neurol Sci. 2014;35(1):31–5.Google Scholar
  2. 2.
    Wöber-Bingöl C. Epidemiology of migraine and headache in children and adolescents. Curr Pain Headache Rep. 2013;17(6):341.CrossRefPubMedGoogle Scholar
  3. 3.
    Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol. 2010;52(12):1088–97.CrossRefPubMedGoogle Scholar
  4. 4.
    Steiner TJ, Stovner LJ, Birbeck GL. Migraine: the seventh disabler. Headache. 2013;33(5):289–90.Google Scholar
  5. 5.
    Bellini B, Arruda M, Cescut A, Saulle C, Persico A, Carotenuto M, Gatta M, Nacinovich R, Piazza FP, Termine C, Tozzi E, Lucchese F, Guidetti V. Headache and comorbidity in children and adolescents. J Headache Pain. 2013;14(1):79.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Minen MT, Begasse De Dhaem O, Kroon Van Diest A, Powers S, Schwedt TJ, Lipton R, Silbersweig D. Migraine and its psychiatric comorbidities. J Neurol Neurosurg Psychiatry. 2016;87(7):741–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Gelfand AA. Psychiatric comorbidity and paediatric migraine: examining the evidence. Curr Opin Neurol. 2015;28(3):261–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Arruda MA, Arruda R, Guidetti V, Bigal ME. Psychosocial adjustment of children with migraine and tension-type headache—a nationwide study. Headache. 2015;55(Suppl 1):39–50.CrossRefPubMedGoogle Scholar
  9. 9.
    Kalaydjian A, Merikangas K. Physical and mental comorbidity of headache in a nationally representative sample of US adults. Psychosom Med. 2008;70(7):773–80.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Minen MT, Tanve K. Influence of psychiatric comorbidities in migraineurs in the emergency department. Gen Hosp Psychiatry. 2014;36(5):533–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Brna P, Gordon K, Dooley J. Canadian adolescents with migraine: impaired health-related quality of life. J Child Neurol. 2008;23(1):39–43.CrossRefPubMedGoogle Scholar
  12. 12.
    Lipton RB, Hamelsky SW, Kolodner KB, Steiner TJ, Stewart WF. Migraine, quality of life, and depression: a population-based case-control study. Neurology. 2000;55(5):629–35.CrossRefPubMedGoogle Scholar
  13. 13.
    Parisi P, Verrotti A, Paolino MC, Ferretti A, Raucci U, Moavero R, Villa MP, Curatolo P. Headache and attention deficit and hyperactivity disorder in children: common condition with complex relation and disabling consequences. Epilepsy Behav. 2014;32:72–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Genizi J, Gordon S, Kerem NC, Srugo I, Shahar E, Ravid S. Primary headaches, attention deficit disorder and learning disabilities in children and adolescents. J Headache Pain. 2013;14:54.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Arruda MA, Guidetti V, Galli F, Albuquerque RCAP, Bigal ME. Migraine, tension-type headache, and attention-deficit/hyperactivity disorder in childhood: a population-based study. Postgrad Med. 2010;122(5):18–26.CrossRefPubMedGoogle Scholar
  16. 16.
    Virtanen R, Aromaa M, Koskenvuo M, Sillanpää M, Pulkkinen L, Metsähonkala L, Suominen S, Rose RJ, Helenius H, Kaprio J. Externalizing problem behaviors and headache: a follow-up study of adolescent Finnish twins. Pediatrics. 2004;114(4):981–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Paolino MC, Ferretti A, Villa MP, Parisi P. Headache and ADHD in pediatric age: possible physiopathological links. Curr Pain Headache Rep. 2015;19(7):25.CrossRefPubMedGoogle Scholar
  18. 18.
    Curone M, Tullo V, Lovati C, Proietti-Cecchini A, D’Amico D. Prevalence and profile of obsessive-compulsive trait in patients with chronic migraine and medication overuse. Neurol Sci. 2014;35(Suppl 1):185–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Dell’osso L, Cassano GB, Sarno N, Millanfranchi A, Pfanner C, Gemignani A, Maser JD, Shear MK, Grochocinski VJ, Rucci P, Frank E. Validity and reliability of the Structured Clinical Interview for Obsessive-Compulsive Spectrum (SCI-OBS) and of the Structured Clinical Interview for Social Phobia Spectrum (SCI-SHY). Int J Methods Psychiatr Res. 2000;9(1):11–24.CrossRefGoogle Scholar
  20. 20.
    Luconi R, Bartolini M, Taffi R, Vignini A, Mazzanti L, Provinciali L, Silvestrini M. Prognostic significance of personality profiles in patients with chronic migraine. Headache. 2007;47(8):1118–24.CrossRefPubMedGoogle Scholar
  21. 21.
    Vasconcelos LPB, Silva MC, Costa EAC, da Silva Júnior AA, Gómez RS, Teixeira AL. Obsessive compulsive disorder and migraine: case report, diagnosis and therapeutic approach. J Headache Pain. 2008;9(6):397–400.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Vulić-Prtorić A, Galić S, Coha R, Grubić M, Lopižić J. Anxiety in children with headaches. Psychol Top. 2007;16(2):201–24.Google Scholar
  23. 23.
    Kyu HH, Pinho C, Wagner JA, Brown JC, Bertozzi-Villa A, Charlson FJ, et al. Global and national burden of diseases and injuries among children and adolescents between 1990 and 2013. JAMA Pediatr. 2016;170(3):267.CrossRefPubMedGoogle Scholar
  24. 24.
  25. 25.
    Aly Z, Rosen N, Evans RW. Migraine and the risk of suicide. Headache. 2016;56(4):753–61.CrossRefPubMedGoogle Scholar
  26. 26.
    Breslau N, Davis GC, Andreski P. Migraine, psychiatric disorders, and suicide attempts: an epidemiologic study of young adults. Psychiatry Res. 1991;37(1):11–23.CrossRefPubMedGoogle Scholar
  27. 27.
    Jette N, Patten S, Williams J, Becker W, Wiebe S. Comorbidity of migraine and psychiatric disorders—a national population-based study. Headache. 2008;48(4):501–16.CrossRefPubMedGoogle Scholar
  28. 28.
    Kim SY, Park SP. Suicidal ideation and risk factors in Korean migraine patients. J Clin Neurosci. 2014;21(10):1699–704.CrossRefPubMedGoogle Scholar
  29. 29.
    Pompili M, Serafini G, Di Cosimo D, Dominici G, Innamorati M, Lester D, et al. Psychiatric comorbidity and suicide risk in patients with chronic migraine. Neuropsychiatr Dis Treat. 2010;6:81–91.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Zanchin G, Bellamio M, Maggioni F. Does suicide cause suicide headache? Headache. 2014;54(4):745–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Wang S-J, Juang K-D, Fuh J-L, Lu S-R. Psychiatric comorbidity and suicide risk in adolescents with chronic daily headache. Neurology. 2007;68(18):1468–73.CrossRefPubMedGoogle Scholar
  32. 32.
    Wang S-J, Fuh J-L, Juang K-D, Lu S-R. Migraine and suicidal ideation in adolescents aged 13 to 15 years. Neurology. 2009;72(13):1146–52.CrossRefPubMedGoogle Scholar
  33. 33.
    Luntamo T, Sourander A, Gyllenberg D, Sillanmäki L, Aromaa M, Tamminen T, Kumpulainen K, Moilanen I, Piha J. Do headache and abdominal pain in childhood predict suicides and severe suicide attempts? Finnish Nationwide 1981 Birth Cohort Study. Child Psychiatry Hum Dev. 2014;45(1):110–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Wöber-Bingöl Ç, Wöber C, Uluduz D, Uygunoğlu U, Aslan TS, Kernmayer M, Zesch HE, Gerges NT, Wagner G, Siva A, Steiner TJ. The global burden of headache in children and adolescents—developing a questionnaire and methodology for a global study. J Headache Pain. 2014;15:86.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Ferracini GN, Dach F, Speciali JG. Quality of life and health-related disability in children with migraine. Headache. 2014;54(2):325–34.CrossRefPubMedGoogle Scholar
  36. 36.
    Genizi J, Khourieh Matar A, Schertz M, Zelnik N, Srugo I. Pediatric mixed headache—the relationship between migraine, tension-type headache and learning disabilities—in a clinic-based sample. J Headache Pain. 2016;17:42.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Parisi P, Verrotti A, Paolino MC, Urbano A, Bernabucci M, Castaldo R, Villa MP. Headache and cognitive profile in children: a cross-sectional controlled study. J Headache Pain. 2010;11(1):45–51.CrossRefPubMedGoogle Scholar
  38. 38.
    Gesztelyi G, Bereczki D. Disability is the major determinant of the severity of depressive symptoms in primary headaches but not in low back pain. Cephalalgia. 2005;25(8):598–604.CrossRefPubMedGoogle Scholar
  39. 39.
    Blaauw BA, Dyb G, Hagen K, Holmen TL, Linde M, Wentzel-Larsen T, Zwart JA. Anxiety, depression and behavioral problems among adolescents with recurrent headache: the Young-HUNT study. J Headache Pain. 2014;15:38.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Arita JH, Lin J, Pinho RS, Minett TS, de Souza Vitalle MS, et al. Adolescents with chronic migraine commonly exhibit depressive symptoms. Acta Neurol Belg. 2013;113(1):61–5.CrossRefPubMedGoogle Scholar
  41. 41.
    Falavigna A, Teles AR, Braga GL, Conzatti LP, Ruschel LG, Silva PG. Association between primary headaches and depression in young adults in southern Brazil. Rev Assoc Med Bras. 2013;59(6):589–93.CrossRefPubMedGoogle Scholar
  42. 42.
    Monteith TS, Sprenger T. Tension type headache in adolescence and childhood: where are we now? Curr Pain Headache Rep. 2010;14(6):424–30.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Galli F, D’Antuono G, Tarantino S, Viviano F, Borrelli O, Chirumbolo A, Cucchiara S, Guidetti V. Headache and recurrent abdominal pain: a controlled study by the means of the child behavior checklist (CBCL). Cephalalgia. 2007;27:211–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Ligthart L, Gerrits MM, Boomsma DI, Penninx BW. Anxiety and depression are associated with migraine and pain in general: an investigation of the interrelationships. J Pain. 2013;14(4):363–70.CrossRefPubMedGoogle Scholar
  45. 45.
    Öztop DB, Taşdelen Bİ, PoyrazoğLu HG, Ozsoy S, Yilmaz R, Şahın N, Per H, Bozkurt S. Assessment of psychopathology and quality of life in children and adolescents with migraine. J Child Neurol. 2016;31(7):837–42.CrossRefPubMedGoogle Scholar
  46. 46.
    Rousseau-Salvador C, Amouroux R, Annequin D, Salvador A, Tourniaire B, Rusinek S. Anxiety, depression and school absenteeism in youth with chronic or episodic headache. Pain Res Manag. 2014;19(5):235–40.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Kaczynski KJ, Claar RL, Lebel AA. Relations between pain characteristics, child and parent variables, and school functioning in adolescents with chronic headache: a comparison of tension-type headache and migraine. J Pediatr Psychol. 2013;38(4):351–64.CrossRefPubMedGoogle Scholar
  48. 48.
    Yang Y, Zhao H, Heath AC, Madden PA, Martin NG, Nyholt DR. Shared genetic factors underlie migraine and depression. Twin Res Hum Genet. 2016;19(4):341–50.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Lantéri-Minet M, Radat F, Chautard MH, Lucas C. Anxiety and depression associated with migraine: influence on migraine subjects’ disability and quality of life, and acute migraine management. Pain. 2005;118(3):319–26.CrossRefPubMedGoogle Scholar
  50. 50.
    Javidi H, Yadollahie M. Post-traumatic stress disorder. Int J Occup Environ Med. 2012;3(1):2–9.PubMedGoogle Scholar
  51. 51.
    Nooner KB, Linares LO, Batinjane J, et al. Factors related to posttraumatic stress disorder in adolescence. Trauma Violence Abuse. 2012;13(3):153–66.CrossRefPubMedGoogle Scholar
  52. 52.
    Zhang J, Zhu S, Changhui D, Ye Z. Posttraumatic stress disorder and somatic symptoms among child and adolescent survivors following the Lushan earthquake in China: a six-month longitudinal study. J Psychosom Res. 2015;79(2):100–6.CrossRefPubMedGoogle Scholar
  53. 53.
    Juang KD, Wang SJ, Fuh JL, SR L, Chen YS. Association between adolescent chronic daily headache and childhood adversity: a community-based study. Cephalalgia. 2004;24:54–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Smitherman TA, Kolivas ED. Trauma exposure versus posttraumatic stress disorder: relative associations with migraine. Headache. 2013;53(5):775–86.CrossRefPubMedGoogle Scholar
  55. 55.
    Juang KD, Yang CY. Psychiatric comorbidity of chronic daily headache: focus on traumatic experiences in childhood, post-traumatic stress disorder and suicidality. Curr Pain Headache Rep. 2014;18(4):405.CrossRefPubMedGoogle Scholar
  56. 56.
    Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci. 2009;10(6):434–45.CrossRefPubMedGoogle Scholar
  57. 57.
    Kuhlman KR, Geiss EG, Vargas I, Lopez-Duran NL. Differential associations between childhood trauma subtypes and adolescent HPA-axis functioning. Psychoneuroendocrinology. 2015;54:103–14.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Beesdo K, Knappe S, Pine DS. Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatr Clin North Am. 2009;32(3):483–524.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Machnes-Maayan D, Elazar M, Apter A, Zeharia A, Krispin O, Eidlitz-Markus T. Screening for psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain. Pediatr Neurol. 2014;50(1):49–56.CrossRefPubMedGoogle Scholar
  60. 60.
    Tarantino S, De Ranieri C, Dionisi C, Citti M, Capuano A, Galli F, Guidetti V. Clinical features, anger management and anxiety: a possible correlation in migraine children. J Headache Pain. 2013;14:39.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Tarantino S, De Ranieri C, Dionisi C, Gagliardi V, Capuano A, Vigevano F, Gentile S, Valeriani M. Migraine equivalents and related symptoms, psychological profile and headache features: which relationship? J Headache Pain. 2015;16:536.CrossRefPubMedGoogle Scholar
  62. 62.
    Fielding J, Young S, Martin PR, Waters AM. Headache symptoms consistent with migraine and tension-type headaches in children with anxiety disorders. J Anxiety Disord. 2016;40:67–74.CrossRefPubMedGoogle Scholar
  63. 63.
    Fujita M, Fujiwara J, Maki T, Shibasaki K, Shigeta M, Nii J. Pediatric chronic daily headache associated with school phobia. Pediatr Int. 2009;51(5):621–5.CrossRefPubMedGoogle Scholar
  64. 64.
    Smitherman TA, Kolivas ED, Bailey JR. Panic disorder and migraine: comorbidity, mechanism, and clinical implications. Headache. 2013;53:23–45.CrossRefPubMedGoogle Scholar
  65. 65.
    APA. American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington: American Psychiatric Association; 2013. p. 87–122, 733–837.Google Scholar
  66. 66.
    Masruha MR, Lin J, Minett TS, Vitalle MS, Fisberg M, Vilanova LC, Peres MF. Social anxiety score is high in adolescents with chronic migraine. Pediatr Int. 2012;54(3):393–6.CrossRefPubMedGoogle Scholar
  67. 67.
    Cappucci S, Simons LE. Anxiety sensitivity and fear of pain in paediatric headache patients. Eur J Pain. 2015;19(2):246–52.CrossRefPubMedGoogle Scholar
  68. 68.
    Noseda R, Kainz V, Borsook D, Burstein R. Neurochemical pathways that converge on thalamic trigeminovascular neurons: potential substrate for modulation of migraine by sleep, food intake, stress and anxiety. PLoS One. 2014;9(8):e103929.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Marco A. Arruda
    • 1
  • Noemi Faedda
    • 2
  • Giulia Natalucci
    • 2
  • Vincenzo Guidetti
    • 2
    Email author
  1. 1.Child and Adolescent Neurologist, Glia InstituteRibeirao PretoBrazil
  2. 2.Department of Paediatrics and Child and Adolescent NeuropsychiatrySapienza University of RomeRomeItaly

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