Headache. 2011 Nov 11.
Depression and Anxiety in Episodic and Chronic Cluster Headache: A Pilot Study.
Robbins MS, Bronheim R, Lipton RB, Grosberg BM, Vollbracht S, Sheftell FD, Buse DC.
SourceFrom The Montefiore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (M.S. Robbins, R. Bronheim, R.B. Lipton, B.M. Grosberg, S. Vollbracht, F.D. Sheftell, and D.C. Buse); North Shore Hebrew Academy High School, Great Neck, NY, USA (R. Bronheim); The New England Center for Headache, Stamford, CT, USA (F.D. Sheftell).

Abstract
Background.- In contrast to migraine and tension-type headache, the psychiatric comorbidities of cluster headache (CH) have not been well-studied. Objective.- We assessed the presence of depression and anxiety in groups of episodic CH (ECH) and chronic CH (CCH) patients and compared CH patients with and without depression and anxiety. Methods.- Sociodemographics, comorbidities, and selected headache features were ascertained from a clinic-based sample in a cross-sectional fashion from January 2007 to July 2010. Active depression and anxiety were assessed using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) scales. Results.- Of 49 CH patients, ECH patients (n = 32) had an earlier age of onset and consumed less caffeine than CCH patients (n = 17). Rates of depression as defined by a PHQ-9 score =10 were low in both ECH (6.3%) and in CCH (11.8%) with similar mean PHQ-9 scores (3.1 vs 3.7, P = .69). Rates of anxiety as defined by a GAD-7 score =10 were also low in both ECH (15.6%) and CCH (11.8%) with similar mean GAD-7 scores (3.8 vs 3.4, P = .76).

ECH PATIENTS IN AND OUT OF ACTIVE ATTACK PERIODS HAD SIMILAR LEVELS OF DEPRESSION AND ANXIETY. DEPRESSION AND ANXIETY USUALLY OCCURRED TOGETHER IN ECH AND CCH PATIENTS. CH PATIENTS WHO WERE DEPRESSED OR ANXIOUS WERE MORE LIKELY TO PRESENT AT A YOUNGER AGE AND HAVE ATTACK-RELATED NAUSEA AND PRODROMAL SYMPTOMS. DEPRESSED CH PATIENTS WERE ALSO MORE LIKELY TO HAVE ANOTHER PAIN DISORDER AND HAD UNDERTAKEN TWICE AS MANY PROPHYLACTIC MEDICATION TRIALS. CONCLUSION.- IN THIS CLINIC-BASED CROSS-SECTIONAL STUDY, ECH AND CCH PATIENTS HAD SIMILARLY LOW RATES OF DEPRESSION AND ANXIETY. RATES WERE LOWER THAN THOSE REPORTED FOR BOTH EPISODIC AND CHRONIC MIGRAINE.

© 2011 American Headache Society.

PMID:22077836[PubMed]

Interesting. I'm not sure what to make of this study, since my experience (and ours on this site) demonstrate a strong correlation to both depression and anxiety when the pain is highest and most prolonged. I am not familiar with the instruments listed, nor the population tested. But I do wonder if there aren't some other factors at play when comparing migraines to CHs. For example, the pain of a migraine may be compared to a steady grinding over long periods of time, while the pain of a CH may be more like a sharp an sudden strike which is of a briefer duration. I wonder if it isn't something like: when the episode ends, so does the pain, with interludes of relatively normal activity. Perhaps the anxiety and depression then are more related to the actual attack than to the individuals psyche? And does the repetition of pain vs. relief help build a personal resiliency not generally present in migraine sufferers? A resiliency not based on character but on the nature of the pain's onset and cessation? I just don't find the conclusions terribly satisfying. Blessings. lance

I tend to lead a very structured life with planned out days/nights and the TORTURE of my DRAGON often prohibits me from keeping on schedule due to unpredictable interruptions.  No doubt I am depressed! 

These past 4 & 1/2 months in cycle i've lost countless fun opportunities with my 11 yr old son "watching from the sidelines" instead of actively participating.  I've also lost my girlfriend of 4 yrs, my job, patience, motivation and general optimistic upbeat attitude.  In fact i've went from being a sociable extrovert "life of the party" type guy to a lonely irritable introvert.

This has been the worst cycle I recall in 32 yrs of CH's.  Maybe a 6 yr remission is the reason for me feeling tremendous depression as I thought CH's had finally become a living nightmare of my past and on 8/6th I got a "rogue hit" that started it all again.

The DRAGON has drained me physically, emotionally, and financially.  However, thanks to a documented log of attacks, i've had a bit more control this past month as I am able to plan around my known "scheduled attack times" and this has provided me better control of my life, thus less depression.

Hopefully i'm nearing the end of my cycle and believe I am as my recently increased Verapamil dosage has finally provided a few good nights of sleep and better productivity during the mornings and days.  My head is still clenched tightly from the DRAGON's CLAWS, but am in much better control compared to what i've endured these past several months, thus less depression.

The ole saying "misery loves company" is proven true for me this cycle and believe in one creating a self-prophecy as to what direction one will lead their life.  "Destiny is not a matter of chance, it is a matter of choice."  I try my best to always think optimistically, however this cycle the "domino effect" and "Murphy's Law" went hand in hand triggered by my DRAGON.

On the last week of each year I sit down with pen/paper and scrutinize the past 52 weeks.  Critically evaluating myself of good times/bad times and make resolutions to better the upcoming New Year and future.  Next week will be no different except I must add to my New Year Resolutions list (1) positive strategies to get out of my depressed thinking mode, (2) better understanding of my CH's for present/future, (3) more quality time with my son, (4) secure a job and (5) eventually find another woman.  These 5 resolutions were not on last years list.  But because the DRAGON forced his way into my 2011, these 5 resolutions must be at the top of my 2012 resolutions list.

Wishing all here at Clusterville Season's Greetings with minimal/no depression, PFDAN, a Happy Chanukah, Merry Christmas and Wishing everybody at CH.com less pain w/ more productivity in their lives in 2012.

-Gregg in Las Vegas