Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Saraswati Dental College
Lucknow
On Sep 2018




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Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : July | Volume : 15 | Issue : 7 | Page : VC01 - VC05 Full Version

A Cross-sectional Study to Assess Psychiatric Co-morbidity among Patients of Migraine and Other Headaches


Published: July 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/49515.15078
Pir Dutt Bansal, Deepika Garg, Priyanka Bansal, Bhavneesh Saini

1. Associate Professor and Head (Nodal Officer), Department of Psychiatry and Deaddiction, GGSMCH, Faridkot; Deaddiction Centre, Civil Hospital, Bathinda, Punjab, India. 2. Consultant Psychiatrist (MO), Department of Psychiatry and Deaddiction, Deaddiction Centre, Civil Hospital, Bathinda, Punjab, India. 3. Senior Resident, Department of Psychiatry and Deaddiction, GGSMCH, Faridkot and Deaddiction Centre, Civil Hospital, Bathinda, Ferozepur, Punjab, India. 4. Senior Resident, Department of Psychiatry and Deaddiction, GGSMCH, Faridkot and Deaddiction Centre, Civil Hospital, Bathinda, Patiala, Punjab, India.

Correspondence Address :
Priyanka Bansal,
House No. 40/4, Street No. 1, Ferozepur Cantt, Ferozepur, Punjab, India.
E-mail: priyankabansal2291@gmail.com

Abstract

Introduction: Migraine is the most common cause of vascular headache with a one-year prevalence as high as 6-14.3%. Having various pathophysiological theories, it occurs in much co-morbidity with several medical as well as psychiatric disorders like mood disorders, phobia, anxiety spectrum, etc. Migraine, especially when co-morbid with psychiatric illness stands markedly burdensome economically, diagnostically, therapeutically and prognostically. Hence, needs even further research.

Aim: To study patients with migraine versus other types of headache and to study psychiatric co-morbidity among patients with migraine.

Materials and Methods: This cross-sectional study was conducted on total 100 patients presenting with headache, meeting the criteria were taken up for the study and divided into two groups. Patients meeting International Headache Society (IHS) criteria for migraine were enrolled under group A and patients suffering from headache other than migraine under group B. Having subjected to detailed history and evaluation, patients were subjected to Symptom checklist-80, Hamilton’s Anxiety Rating Scale (HARS) and Montgomery Asberg Depression Rating Scale (MADRS), International Classification of Diseases (ICD)-10 criteria. The data so collected was subjected to statistical analysis and association of psychiatric morbidity with migraine patients was assessed.

Results: Patients with migraine (group A) and among those too, patients having psychiatric morbidity had significantly (p<0.01) longer duration of illness (≥8 years), more frequent attacks ≥5 attacks per month and had longer duration of each attack >24 hours compared to the other groups. Patients having migraine had significantly (p<0.01) higher psychiatric morbidity, more SCL-80 symptoms (mean score 83.05); more depressive symptoms (mean MADRS score was 31.9±9.2) and more anxiety with the mean Hamilton Anxiety score was 23.3 than in patients without psychiatric morbidity.

Conclusion: A thorough evaluation of psychiatric disorders in migraine is important so as to propose a non segregated model of care to direct the burden and deterioration associated with psychiatric co-morbidity in migraine.

Keywords

Mood disorder, Pathophysiological theories, Psychiatric illness

Headache stands as the most prevailing and disabling public health problem with 64% lifetime prevalence. Primary headaches are the most common with migraine being second most common of these (1),(2). Broadly, the International Classification of Headache Disorders, classifies migraine under two types: Migraine without aura and Migraine with aura (3). With a one-year prevalence rate as high as 10-14%, it adds much to the global disease burden with almost 959 million people estimated to be suffering from migraine worldwide (4).

Multiple pathophysiological theories (genetic, vascular, neurological, cellular) contribute to strong association of migraine with numerous medical disorders like inflammatory conditions, neurological, respiratory, allergic, cardiovascular diseases etc., (5). As many as 9-58% patients have psychiatric co-morbidity that includes mood disorders, phobias, anxiety disorders and depression (6),(7). The psychiatric co-morbidities and migraine bidirectionally influence each other. Leaving one unaddressed complicates the management, increases the morbidity due to other (8).

Together, these are prevalent and burdensome conditions challenging the healthcare system worldwide yet remaining underdiagnosed and underrated with a lack of multifaceted disease approach (9). Hence, the present study aimed to add light to this undervalued co-existing pattern sighting better diagnostic and management plans in near future with objectives;

• To study and compare patients with migraine versus other types of headache.
• To study psychiatric co-morbidity among patients with migraine.

Material and Methods

This was a cross-sectional study conducted in the Department of Psychiatry of a tertiary care hospital in North India over a period of six months (January 2020 to June 2020). Approval for conducting the study was taken from Institutional Ethics Committee.

Sample size calculation: Hundred patients selected by convenient sampling method were taken for the study. The prevalence of headache disorders was variable in studies. As per the World Health Organisation (WHO), the prevalence of headache disorder is 50% (10), while, based on the departmental data of previous year, prevalence was 7%. For the purpose of current study, 50% prevalence, with 20% error was taken for calculating sample size as per formula:

n=4pq/d2
n=4×50×50/102=100

Based on the patients’ availability and feasibility, and considering tentative dropouts, 100 patients were chosen, out of which 20 patients did not fulfill inclusion/exclusion criteria or didn’t consent for the study, so, final data analysis was conducted on 80 patients.

Hundred patients selected by convenient sampling with complaint of headache, presenting to the Department of Psychiatry or Neurology were initially screened. Subjects fulfilling the inclusion and exclusion criteria were then selected.

Inclusion and Exclusion criteria: Patients of both sexes, aged 20-60 years, presenting with complaint of headache were included. Patients suffering from epilepsy, mental retardation, pregnant females, any organic brain disorders, acute or chronic medical illness or who are on long-term treatment for any other medical/psychiatric conditions were excluded.

Study Procedure

Patients meeting International Headache Society (IHS) criteria (3) for Migraine were among group A, while the rest either not fulfilling complete IHS criteria, or having tension type of headache were enlisted as group B. Care was taken that both groups had similar socio-demographic attributes like age and sex. Selected patients were subjected to detailed psychiatric examination after completing personal bio-data proforma. All the subjects were subjected to suitable scales like Symptom Checklist-80 (SCL-80) (11) and HARS (12) and MADRS (13) for psychiatric symptom evaluation and severity assessment. Psychiatric diagnosis, if any, was made using ICD-10 diagnostic guidelines (14), along with the scales. Further assessment of psychiatric co-morbidity with migraine and other types of headache was assessed using statistical analysis.

Instruments

1. Personal biodata proforma: Consists of all socio-demographic and illness-related variables.
2. Symptom Checklist 80 (SCL-80): It consists of 80 items divided into nine subscales- somatisation, depression, paranoid ideation, interpersonal sensitivity, phobia, anxiety, Obsessive Compulsive Disorder (OCD) anger hostility, and additional symptoms. Each item had maximum score of 4 depending upon severity as absent, mild, moderate and severe (11).
3. Hamilton’s Anxiety Rating Scale (HARS): Semi-quantitative scale was used to assess severity of anxiety. It has 14 items, rated from 0 to 3. Scoring is as- 0-5 (no anxiety), 6-10 (mild), 11-15 (moderate), and >15 (severe anxiety) (12).
4. Montgomery Asberg Depression Rating Scale (MADRS): Includes 10 symptoms of depression. The rating is based on clinical interview which moves from broad questions to detailed ones. Rater decides whether score lies on defined scale steps (0,2,4,6) or between them (1,3,5). Score of 0-6 means normal/recovered, 7-19 mild, 20-34 moderate, and 35-60 severe depression (13).

Statistical Analysis

The data were entered in Microsoft Excel and analysed using IBM Statistical Package for the Social Science (SPSS) v20.1. Descriptive statistics for categorical variables are presented in the form of frequencies, and continuous variables, in the form of mean and standard deviation. Association between various parameters was explored using Pearson’s Chi-square test. The p-values of significance ≤0.05 were considered significant.

Results

A total of 100 subjects with complaint of headache were initially included. However, after an initial screening, 20 patients who either did not fulfill the inclusion/exclusion criteria or didn’t consent for the study were excluded. Final analysis was thus, conducted on 80 patients.

(Table/Fig 1) shows that group A had significantly more (52%) patients hailing from rural areas than group B (26.7%) (p=0.03). Considering migraine patients, those with psychiatric morbidity were significantly older in age (Mean=31.6 years, p=0.04), married (75.7%, p-value=0.04), and literate (78.4%, p-value=0.03) as compared to those without morbidity.

Migraine characteristics depicted in (Table/Fig 2) shows that patients in group A (52%) had longer duration of illness (≥8 years), had more frequent migraine attacks ≥5 per month (34%) with longer duration of each attack ≥24 hours (64%), as compared to group B (p-value=0.002, 0.006, 0.001, respectively). Specifically, among migraine patients’ higher number of patients with psychiatric morbidity (62.2%) had longer (≥8 years) duration of illness, more frequent attacks ≥5 per month (40.5%), and longer duration of each attack ≥24 hours (81.1%) (p-value=0.008, 0.032, <0.001, respectively).

It was seen (Table/Fig 3) that group A patients had significantly higher scores in terms of overall psychiatric morbidity (SCL-80 mean score of 69.34 versus 38.8 in group B); higher depression scores (MADRS mean 26.3 versus 11.6 in group B) and higher anxiety scores (HARS mean 20.04 versus 11.8 in group B). Migraine patients with psychiatric morbidity had significantly more SCL-80 symptom score (Mean=83.1 versus 30.30 in patients without morbidity), more depressive symptoms (MADRS mean 31.9 versus 10.2 in those without morbidity), and more anxiety (HARS mean=23.3 versus 10.8 in patients without morbidity).

Considering individual subscales of SCL-80, as depicted in (Table/Fig 4), (Table/Fig 5), significantly higher number of patients in group A had symptoms of somatisation, depression, moderate anxiety and OCD. In these subscale categories, more group A patients belonged to moderate and severe categories than group B which had no patient falling in moderate severity.

Considering patients fulfilling ICD-10 diagnostic criteria for established psychiatric disorders (Table/Fig 6), more group A patients were diagnosed with depression (24%), generalised anxiety disorder (26%), somatisation (18%) and OCD (6%), as compared to group B (p-value=0.02).

Lastly, as stated in (Table/Fig 7), significantly (p-value=0.01) higher number of migraine patients with psychiatric morbidity had a family history of migraine (n=14, 37.8%) compared to those without psychiatric morbidity.

Discussion

The present study was conducted to find out psychiatric morbidity among patients of migraine and any relation of psychiatric morbidity with socio-demographic attributes and variables of migraine. For this purpose, 50 patients of migraine were enrolled which constituted group A and 30 patients having headache other than migraine were also enrolled who constituted group B.

It could be observed (Table/Fig 1) that number of females in group A was more as compared to males (76% versus 24%). Banday M et al., found females (90.7%) being widely numerous than males (9.3%) with a mean age of 35.38-38.80 (15).

In patients with psychiatric morbidity, there were significantly (p-value <0.05) higher number of females (83.8%) than male patients, with a mean age of 31.6 years, belonging to urban areas, married, housewives, literate and having moderate income. Bera SC et al., stated such patients to have a mean age of 33.45 years, with significantly wide majority of them being females, married home-makers, middle-school literates, rural background (2). Although some literature states variability too which might be accounted to socio-cultural differences with geographical differences (6).

Majority patients with migraine had significantly longer duration of migraine i.e., ≥8 years, had more frequent attacks i.e., ≥5 per month and also longer (≥24 hours) duration of each attack. On analysing disease variables (Table/Fig 2), significantly higher number of patients with migraine and psychiatric morbidity had longer duration of illness ≥8 years (p-value=0.008), had more frequent migraine attacks ≥5 attacks/month (p-value=0.032) and had longer duration of each attack ≥24 hours (p-value<0.001). Maizels M and Burchette R concluded that frequent association of somatic symptoms in patients with chronic migraine; in patients with severe headache >2 days/week compared to <2 days/week and in patients with a clinical diagnosis of anxiety or depression (16). Some literature although state it otherwise (6),(17).

As depicted in (Table/Fig 3), (Table/Fig 4), (Table/Fig 5), Group A had significantly more severe somatisation and depression (p-value=0.001) on the SCL-80 individual subscales. The symptoms of anxiety (8%, mean=11.28, p-value <0.01), OCD (2%, mean=7.12, p<0.05) and additional subscale (10%, mean=7.8, p<0.01) were moderately severe with a total SCL-80 mean score of 69.34 in group A. Minen MT et al., found that among the patients suffering from migraine, 41-47% suffered from depression, 51-58% from anxiety (7).

On MADRS, significantly (p<0.01) higher number of patients in group A showed symptoms of depression with mean score of 26.3. Fugger G et al., found MADRS too similarly with majority patients experiencing recurrent depressive episodes with a mean MADRS score of 24.8 (18).

On HARS, significantly (p-value <0.01) higher number of patients showed symptoms of anxiety with mean score of 20.04. Zampieri MA et al., could trace neuroticism in as many as 90% chronic migraine patients with almost half having anxiety disorder and half having depressive disorder (19).

On MADRS and HARS, significantly (p-value <0.001) more symptoms of depression and anxiety were observed in patients with psychiatric morbidity with mean score of 31.94 and 23.27, respectively. Pradeep R et al., found many patients with migraine to have co-morbid anxiety or depression with scores holding a direct correlation with the HAM-A and HAM-D scores (1). As per ICD-10 criteria (Table/Fig 6), significantly higher (p=0.02) number of patients in group A were diagnosed as Depression F32, Generalised Anxiety Disorder, Somatisation F45 and OCD F42. Bera SC et al., concluded that among the total (62.5%) patients with psychiatric disorders, majority fulfilled criteria for major depressive disorder, social phobia, substance abuse, bipolar disorder, generalised anxiety disorder and though lesser but also with Obsessive Compulsive Disorder (2).

In the current study (Table/Fig 7), significantly higher number of migraine patients with psychiatric morbidity had positive family history of migraine (37.83%) as compared to 7.7% in patients without psychiatric morbidity. Bhatia M and Gupta R, found 12% of cases to have a positive family history and 6% having family history of depression and migraine with aura as the most common subtype (80%) (20).

Considering strengths of current study, it strongly focuses on the wide co-occurrence of headache (in particular migraine) with various psychiatric symptoms as well as diagnostic disorders, which has been done in relatively fewer studies in north India. To delineate amongst patients with headache as part of underlying psychopathology versus primary headache disorder, a precise wholesome neuro psychiatric history taking was done using semi-structure proforma. This was further reinforced using appropriate scales and the standard IHS and ICD-10 criteria. For future recommendations, current study draws attention towards a multifaceted approach in headache management, to reduce burden on such patients in all spheres.

Limitation(s)

Current study was cross-sectional in nature. A longitudinal pattern would help assessing long-term course and prognosis of headache patients, especially those with psychiatric co-morbidity. Secondly, a higher sample size will better help generalising the results in population.

Conclusion

Compared to other headaches, migraine patients, especially those having psychiatric morbidity were found to have longer duration of illness, more frequent attacks and longer duration of each attack. Further, such patients had higher overall psychiatric morbidity, including symptoms of somatisation, depression, anxiety, OCD and depression. As per ICD-10 diagnostic criteria for psychiatric disorders, more migraine patients suffered from Depression (F32), Generalised Anxiety disorder (F41), Somatisation disorder (F45) and OCD (F42).

References

1.
Pradeep R, Nemichandra SC, Harsha S, Radhika K. Migraine disability, quality of life, and its predictors. Ann Neurosci. 2020;27(1):18-23. [crossref] [PubMed]
2.
Bera SC, Khandelwal SK, Sood M, Goyal V. A comparative study if psychiatric comorbidity, quality of life and disability in patients with migraine and tension type headache. Neurol India. 2014;62(5):516-20. [crossref] [PubMed]
3.
International Headache Society. IHS Classification ICHD-3 [Internet]. London (UK): IHS; 2018 [cited 2021 Apr 11]. Available from: https://ichd-3.org/1-migraine/.
4.
Steiner TJ, Stovner LJ, Vos T. GBD 2015: Migraine is the third cause of disability in under 50s. J Headache Pain. 2016;17:104. [crossref]>[crossref]
5.
Gupta VK. Pathophysiology of migraine: An increasingly complex narrative to 2020. Future Neurol. 2019;14(2):FNL 13. [crossref]
6.
Buse DC, Reed ML, Fanning KM, Bostic R, Dodick DW, Schwedt TJ, et al. Comorbid and co-occuring conditions in migraine and associated risk of increasing headache pain intensity and headache frequency: Results of the migraine in Maerica symptoms and treatment (MAST) study. J Headache Pain. 2020;21:23. [crossref] [PubMed]
7.
Minen MT, De Dhaem OB, Van Diest AK, Powers S, Schwedt TJ, Lipton R, et al. Migraine and its psychiatric comorbidities. J Neurol Neurosurg Psychiatry. 2016;87:741-49. [crossref] [PubMed]
8.
Jeyagurunathan A, Abdin E, Vaingankar JA, Chua BY, Shafie S, Chang SH, et al. Prevelance and comorbidity of migraine headache: Results from the Singapore Mental Health Study 2016. Soc. Psychiatry Psychiatr. Epidemiol. 2020;55:33-43. [crossref] [PubMed]
9.
Takeshima T, Wan Q, Zhang Y, Komori M, Stretton S, Rajan N, et al. Prevalence, burden, and clinical management of migraine in China, Japan, and South Korea: A comprehensive review of the literature. J Headache Pain. 2019;20(111):01-15. [crossref] [PubMed]
10.
World Health Organization. Headache disorders [Internet]. Geneva, CH: WHO; 2016 [updated 2016; cited 2021 Apr 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/headache-disorders.
11.
Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory. Behav Sci. 1974;19(1):01-15. [crossref] [PubMed]
12.
Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50-55. [crossref] [PubMed]
13.
Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. BJPsych. 1979;134(4):382-89. [crossref] [PubMed]
14.
World Health Organization. The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. In ed. Geneva: AITBS; 2007. Pp. 362.
15.
Banday M, Wani M, Farooq U, Parra B, Rather. Sociodemographic and comorbidity profiles of migraine patients: An outpatient based study in a tertiary care hospital. Asian J Pharm Clin Res. 2020;13(8):59-64. [crossref]
16.
Maizels M, Burchette R. Somatic symptoms in headache patients: The influence of headache diagnosis, frequency and comorbidity. Headache. 2004;44(10):983-93. [crossref] [PubMed]
17.
Lipton RB, Seng EK, Chu KM, Reed ML, Fanning KM, Adams AM, et al. The effect of psychiatric comorbidities on headache-related disability in migraine: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache. 2020;60:1683-96. [crossref] [PubMed]
18.
Fugger G, Dold M, Bartova L, Mitschek MM, Souery D, Mendlewicz J, et al. Clinical correlates and outcome of major depressive disorder and comorbid migraine: A report of the European group for the study of resistant depression. Int J Neuropsychopharmacol. 2020;23(9):571-77. [crossref] [PubMed]
19.
Zampieri MA, Tognola WA, Galego JC. Patients with chronic headache tend to have more psychological symptoms that those with sporadic episodes of pain. Arq Neuropsiquiatr. 2014;72(8):598-602. [crossref] [PubMed]
20.
Bhatia M, Gupta R. Migraine: Clinical pattern and psychiatric comorbidity. Ind Psychiatry J. 2012;21(1):18-21. [crossref] [PubMed]

DOI and Others

10.7860/JCDR/2021/49515.15078

Date of Submission: Mar 19, 2021
Date of Peer Review: Apr 07, 2021
Date of Acceptance: May 09, 2021
Date of Publishing: Jul 01, 2021

Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 22, 2021
• Manual Googling: May 01, 2021
• iThenticate Software: May 20, 2021 (8%)

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