Morning headaches associated with depression, anxiety disorders

Morning headaches affect about one person in 13 in the general population and are associated with depression and anxiety disorders, according to an article in the January 12 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, waking up with a headache is traditionally associated with sleep disorders. Studies have reported a high association between morning headache and obstructive sleep apnea syndrome, and snoring. The prevalence of morning headache in the general population is not known, although according to a Swedish study, 5 percent of the population often experiences morning headache.

Maurice M. Ohayon, M.D., D.Sc., Ph.D., of Stanford University School of Medicine, Palo Alto, Calif., investigated the prevalence of chronic morning headaches (CMH) in the general population, and their relationship to sociodemographic characteristics, controlled substance use, and clinical, sleep and mental disorders.

A telephone questionnaire was used to survey 18,980 people (15 years or older) representative of the populations of the United Kingdom, Germany, Italy, Portugal, and Spain. The questionnaire included questions about morning headaches, clinical disorders, use of psychoactive substances, and sleep and mental disorders.

Overall, the prevalence of CMH was 7.6 percent (n=1,442). CMH were reported to occur “daily” by 1.3 percent of the individuals surveyed; “often” by 4.4 percent of the survey sample; and “sometimes” by 1.9 percent of the sample. Rates were higher in women than in men (8.4 percent vs. 6.7 percent) and in people aged between 45 and 64 years (about 9 percent). The most significant factors associated with CMH were anxiety and depressive disorders.

Dr. Ohayon also found that CMH was significantly associated with sleep-related breathing disorders, hypertension, musculoskeletal diseases, use of anxiolytic medication and heavy alcohol consumption.

“Morning headache affects one individual in 13 in the general population,” Dr. Ohayon writes. “Chronic morning headaches are a good indicator of major depressive disorders and insomnia disorders. Contrary to what was previously suggested, however, they are not specific to sleep-related breathing disorder,” concludes Dr. Ohayon.

(Arch Intern Med. 2004;164:97-102. Available post-embargo at archinternmed.com)

Editor’s Note: This study was supported by an unrestricted educational grant from the Sanofi-Synthelabo Group and by a grant from the Fond de la Recherche en Sante du Quebec.

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