Morning Headache Common in Depression, Anxiety Disorders

Laurie Barclay, MD

January 12, 2004

Jan. 12, 2004 — Morning headache may be a good indicator of depression and insomnia and is not specific to sleep-disordered breathing, according to the results of a telephone survey published in the Jan. 12 issue of the Archives of Internal Medicine.

"The prevalence of morning headache in the general population is not known, although according to a Swedish study, 5% of the population awakens often or very often with headaches," writes Maurice M. Ohayon, MD, DSc, PhD, from Stanford University School of Medicine in California. "Clinical studies have reported a high association between morning headaches and obstructive sleep apnea syndrome and snoring."

The telephone survey used in this study included questions about morning headaches, organic disorders, use of psychoactive substances, and sleep and mental disorders. Of 18,980 people aged 15 years or older surveyed from the general population of the U.K., Germany, Italy, Portugal, and Spain, 1,442 (7.6%) reported chronic morning headache (CMH).

Frequency of CMH was characterized as "daily" by 1.3% of the individuals surveyed, "often" by 4.4%, and "sometimes" by 1.9% of the sample. Median duration of CMH was 42 months. Prevalence of CMH was higher in women than in men (8.4% vs. 6.7%) and in subjects aged between 45 and 64 years (about 9%).

Conditions associated with CMH were comorbid anxiety and depressive disorders (28.5% reported both CMH and the comorbid disease vs. 5.5% who reported CMH without the comorbid disease), sleep-related breathing disorders (15.2% vs. 7.5%), hypertension (11.0% vs. 7.2%), musculoskeletal diseases (14.1% vs. 7.1%), use of anxiolytic medication (20.1% vs.7.3%), and heavy alcohol consumption (12.6% vs. 7.7%).

"Morning headache affects one individual in 13 in the general population," Dr. Ohayon writes. "Recurrent morning headaches in about 80% of cases are related to an identifiable organic, mental or sleep disorder. Physicians should be aware of the multiplicity of factors that can be involved in the complaint of morning headaches and the necessity of conducting a thorough interview with the patient to identify all possible factors."

The Sanofi-Synthelabo Group and the Fond de la Recherche en Sante du Quebec supported this study. Dr. Ohayon reports no financial conflicts of interest.

Arch Intern Med. 2004;164:97-102

Reviewed by Gary D. Vogin, MD

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