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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The atypical subtype of depression appears to be well validated and common, and it is unique among Axis I disorders in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) in that it includes a personality trait, rejection sensitivity, as a criterion. Drug selection remains a challenge for the clinician who treats patients with this subtype of depression. Noradrenergic antidepressants have been thought to have prominent effects in improving such symptoms as loss of motivation, drive, and energy, which are among the core symptoms of patients with atypical depression. Thus it can be speculated that noradrenergic antidepressants might be superior to serotonergic antidepressants in reducing symptoms of atypical depression. This is the first study to compare the efficacy of fluoxetine, a selective reuptake inhibitor of serotonin, and reboxetine, a selective reuptake inhibitor of norepinephrine, in the treatment of patients with atypical depression. A total of 43 patients with atypical depression according to DSM-IV were randomly assigned to receive fluoxetine or reboxetine over an 8-wk clinical trial. Patients with a Structured Clinical Interview for DSM-IV diagnosis of personality disorder accounted for 54% of those with atypical depression in this sample. Patients with personality disorders were typically young and were unable to maintain a marriage. Adverse effects such as dry mouth, sweating, headache, and urinary retention were more prominent in the reboxetine group than among those given fluoxetine. Although a greater number of patients treated with reboxetine dropped out of treatment, the pattern of response was very similar for both drugs, and both were effective in reducing symptoms of depression. The presence of a personality disorder in patients with atypical depression did not affect the response to either of the antidepressants. These findings might suggest that drugs with norepinephrine or a 5-hydroxytryptamine mechanism of action might act through a common pathway, resulting in a similar response in terms of core symptoms of depression. If tolerability, efficacy, and cost-effectiveness of antidepressants are considered, the best antidepressant is the one that can be used by the patient, whether or not a personality disorder accompanies atypical depression.
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PMID:Comparison of the effectiveness of reboxetine versus fluoxetine in patients with atypical depression: a single-blind, randomized clinical trial. 1727 65

Psychiatric comorbidity (prevalence and types) was tested in a naturalistic sample of adult patients with pure migraine without aura, and in two control groups of patients, one experiencing pure tension-type headache and the other combined migraine and tension-type headaches. The study population included 374 patients (158, 110 and 106) from nine Italian secondary and tertiary centres. Psychiatric comorbidity was recorded through structured interview and also screened with the Mini International Neuropsychiatry Interview (MINI). Only anxiety and depression were investigated. Psychiatric disorders were reported by 49 patients (14.6%; 10.9% of patients with migraine, 12.8% of those with tension-type headache and 21.4% of those with combined migraine and tension-type headaches). The MINI interview detected a depressive episode in 59.9% of patients with migraine, 68.3% of patients with tension-type headache and 69.6% of patients with combined migraine and tension-type headaches. Depression subtypes were significantly different across groups (p=0.03). Anxiety (mostly generalised) was reported by 18.4% of patients with migraine, 19.3% of patients with tension-type headache, and 18.4% of patients with combined migraine and tension-type headaches. The values for panic disturbance were 12.7, 5.5 and 14.2, and those for obsessive-compulsive disorders were 2.3, 1.1 and 9.4% (p=0.009). Based on these results, psychopathology of primary headache can be a reflection of the burden of the disease rather than a hallmark of a specific headache category.
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PMID:Headache and anxiety-depressive disorder comorbidity: the HADAS study. 1750 74

Chronic fatigue occurring in previously healthy children and adolescents is a vexing problem encountered by pediatric practitioners and the impact of fatigue in youngsters should not be underestimated. In its severe form, it is often associated with mood disorders. Findings in children and adolescent cases suggest that severe unexplained fatigue might precede the development of fatigue-related illness, such as childhood chronic fatigue syndrome (CCFS). This is a disabling condition characterized by severe disabling fatigue and a combination of symptoms, the prominent features being self-reported impairments in concentration and short-term memory, sleep disturbances and autonomic symptoms that cannot be explained by medical or psychiatric illness. We have encountered such patients with these complaints; their major symptoms include: general fatigue, fever, headache (not migraine), and memory disturbance. From our clinical experience, we have inferred that patients with CCFS might experience changes in brain function levels, which induce an autonomic imbalance and engender symptoms such as general fatigue, higher-order level cognitive dysfunction, and memory disturbance.
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PMID:[School phobia and childhood chronic fatigue syndrome (CCFS)]. 1756 7

Our objective is to report a coincident reduction in headache pain in patients treated with repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD). Two patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of MDD, non-responsive to prior antidepressant treatment who were enrolled in a sham-controlled, double-blind study of rTMS for MDD. After the study, it was revealed that both were in the active-treatment arm. Both patients suffered from near daily headaches and kept logs of headache frequency and severity before, during, and after the study. Headache pain was significantly reduced under double-blind conditions with rTMS treatment, but returned to baseline following cessation of rTMS treatment. Ultimately, when receiving rTMS post-study as a maintenance intervention for MDD (approximately 2 rTMS sessions/week), the positive effects on headache amelioration were sustained. Headache pain is frequently comorbid with mood disorders and has been reported as the most common side effect with rTMS. In these subjects, rTMS was, in fact, associated with relief of depressive symptoms and preexisting headache pain. This indicates that rTMS may be beneficial for both disorders in some patients.
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PMID:Unexpected reduction in migraine and psychogenic headaches following rTMS treatment for major depression: a report of two cases. 1832 51

Pathologies currently defined as temporomandibular disorders may be different in nature. Temporomandibular joint (TMJ) disorders and craniofacial and cervical myogenous pain (MP) are distinct pathologies but may be superimposed and share some etiologic factors. Tension-type headache (TTH) may often be associated with craniofacial and cervical pain, and the same pharmacologic and nonpharmacologic treatment may be efficacious for both. Psychiatric comorbidity (depression and/or anxiety disorder) is less frequent in sheer TMJ disorders, compared with MP and TTH. A screening for the presence of an underlying psychiatric disorder should be part of the clinical evaluation in patients suffering from headache and facial pain.
Curr Pain Headache Rep 2007 Dec
PMID:Temporomandibular disorders and tension-type headache. 1817 83

PRX-00023, a serotonin 1A receptor agonist, was designed to provide high potency and selectivity for its target. To assess the possible therapeutic utility in anxiety, a randomized, double-blind, placebo-controlled trial was conducted in 311 subjects who met the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for generalized anxiety disorder. All subjects underwent a 1-week placebo run-in and were randomized to receive once-daily capsules containing either PRX-00023 (80 mg/d) or placebo for an additional 8 weeks. The primary outcome measure was the Hamilton Anxiety Scale (HAM-A). The Montgomery-Asberg Depression Rating Scale was used as a secondary endpoint to measure depressive symptoms. Statistical testing was performed with analysis of covariance, between baseline and week 8, with baseline values as a covariate. The anxiolytic effect of PRX-00023, compared with placebo, showed trends across all anxiolytic measures but failed to reach significance on the primary endpoint (HAM-A total score). Among the components of the HAM-A total score, the anxious mood item was significantly different from placebo in the PRX-00023-treated group (-1.015 vs -0.748; P = 0.02). The scores of the Montgomery-Asberg Depression Rating Scale were significantly improved compared with placebo at week 8 (-4.5 vs -1.6; P = 0.0094 in the last observation carried forward analysis). PRX-00023 was well tolerated; of note, there were no drug-related serious adverse events, and more patients discontinued due to adverse events in the placebo group (2.9%) than in the PRX-00023 group (1.4%). The most common adverse event was headache, observed in 15.7% and 10.9% of PRX-00023- and placebo-treated patients, respectively. Furthermore, there was no evidence of impaired sexual function, as measured by the Massachusetts General Hospital Sexual Function Scale. Collectively, these results support further clinical investigation of higher doses of PRX-00023 in anxiety and depression.
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PMID:Effects of PRX-00023, a novel, selective serotonin 1A receptor agonist on measures of anxiety and depression in generalized anxiety disorder: results of a double-blind, placebo-controlled trial. 1834 38

Recent literature shows an interest in the relationship between psychiatric disorders and headache. This relationship is complex and multifaceted, with existing studies confirming high rates of comorbidity between psychiatric disorders (especially depression and anxiety) and migraine and tension-type headache, implicating comorbid psychiatric disorders as risk factors for headache progression and chronification, and underscoring the need for assessment and treatment of relevant disorders. A smaller amount of literature has focused on headache that presents exclusively during and secondary to a psychiatric disturbance; this phenomenon has been termed "headache attributed to psychiatric disorder." We review recent developments in the relationship between psychiatric conditions and headache, with a particular focus on headaches attributed to psychiatric disorders, and discuss needed areas for future research.
Curr Pain Headache Rep 2008 Aug
PMID:Headache secondary to psychiatric disorders. 1862 9

Psychiatric disorders, notably mood and anxiety disorders, are frequently associated with migraine and chronic daily headaches. The obsessive-compulsive disorder (OCD) is included in the spectrum of anxiety disorders and may be a comorbid condition in headache patients. However, little information has been reported in the literature about this association. This is an important issue as OCD may contribute to the development or maintenance of treatment-resistant chronic headaches. In this paper, we describe a young female patient with refractory chronic migraine and OCD. Considerations on diagnosis, management and treatment of these comorbid conditions are presented.
J Headache Pain 2008 Dec
PMID:Obsessive compulsive disorder and migraine: case report, diagnosis and therapeutic approach. 1880 64

Fibromyalgia syndrome (FM) is a common chronic pain condition that affects at least 2% of the adult population. Chronic widespread pain is the defining feature of FM, but patients may also exhibit a range of other symptoms, including sleep disturbance, fatigue, irritable bowel syndrome, headaches, and mood disorders. The etiology of FM is not completely understood and the syndrome is influenced by factors such as stress, medical illness, and a variety of pain conditions. Establishing diagnosis may be difficult because of the multifaceted nature of the syndrome and overlap with other chronically painful conditions. A unifying hypothesis is that FM results from sensitization of the central nervous system; this new concept could justify the variety of characteristics of the syndrome. FM symptoms can be musculoskeletal, non-musculoskeletal, or a combination of both; and many patients will also experience a host of associated symptoms or conditions. The ACR classification criteria focus only on pain and disregard other important symptoms; but three key features, pain, fatigue and sleep disturbance, are present in virtually every patient with FM. Several other associated syndromes, including circulatory, nervous, digestive, urinary and reproductive systems are probably a part of the so called central sensitivity or sensitization syndrome. A minority subgroup of patients (30-40%) has a significant psychological disturbance. Psychological factors are an important determinant of any type of pain, and psychological comorbidity is frequent in FM. Psychiatric disorders most commonly described are mood disorders, but psychiatric illness is not a necessary factor in the etiopathogenesis of FM.
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PMID:Symptoms and signs in fibromyalgia syndrome. 1885 5

Milnacipran is a dual-action antidepressant which inhibits both serotonin and norepinephrine reuptake. To our knowledge, it has limited affinity for most monoamine neurotransmitter receptors. With limited pharmacokinetic interaction with the cytochrome 450 system, milnacipran may have a low risk in drug interaction. The present study compares milnacipran with paroxetine, a selective serotonin reuptake inhibitor (SSRI) and which has been used clinically for years to evaluate the efficacy, patient tolerance, and side effects in the treatment of major depression. The study took place in two medical centers located in Northern and Southern Taiwan. Six-three participant who met the Diagnostic and Statistical Manual of Mental Disorder 4th edition (DSM-IV) criteria for a major depressive disorder and a total Hamilton Depression Rating Scale (HAM-D) score > or = 16 on the 17 item scale, were recruited. Participants first received either 100 mg/day of milnacipran (33 participants) or 20 mg/day of paroxetine (30 participants), and were then assessed with HAM-D and clinical global impression scale (CGI) for severity of the illness and global improvement, at the beginning and the end of the first, second, fourth, and eighth weeks of the drug treatment. Thirty-eight patients with major depressive disorder completed the study. No statistically significant differences were observed between the two groups in the reduction of HAM-D and CGI scores. However, side effects such as headache and tremor in the first week, psychomotor retardation and difficulty in concentration in the fourth week, and psychomotor retardation in the eighth week of treatment were significantly lower in the milnacipran group, as compared to that of the paroxetine group. We concluded that milnacipran and paroxetine had similar clinical effectiveness during the eight-week treatment of major depressive disorder. Further investigation is needed to examine the clinical suitability of this drug for patients with liver impairments and for elderly patients suffering from major depression.
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PMID:Lower side effects of milnacipran than paroxetine in the treatment of major depression disorder among Han Chinese in Taiwan. 1928 Aug 83


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