A12. Headache attributed to psychiatric disorder

Introduction

Headaches are commonly associated with various psychiatric disorders, but evidence of a causal relationship is mostly lacking. In the vast majority of cases, probably, headache associated with these disorders reflects common underlying risk factors or aetiologies rather than a causal relationship. However, in order to make any of the diagnoses listed below, a causal relationship between the headache and the psychiatric disorder in question must be established. Thus, the headache either develops simultaneously with the psychiatric disorder or significantly worsens after the psychiatric disorder becomes evident.

Definite biomarkers and clinical proof of headache causation are difficult to obtain, and the diagnosis will often one of exclusion. For example, in a child with separation anxiety disorder, headache should be attributed to this disorder only in those cases where it occurs exclusively in the context of actual or threatened separation, without any better explanation. Similarly, in an adult with panic disorder, headache should be attributed to the disorder only in those cases where it occurs exclusively as one of the symptoms of a panic attack.

The following are offered as candidate criterion sets to facilitate research into the possible causal relationships between certain psychiatric disorders and headache. It is not recommended that they be used routinely in clinical practice to describe associations between headache and comorbid psychiatric disorders.