WRITER: AMY LILLARD
CONTACT: DAVE PEDERSEN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-8032; fax (319) 335-8034
Release: Oct. 21, 1999
Cluster headaches associated with anxiety disorders,
IOWA CITY, Iowa The intense pain of cluster
headaches may not be the only worry for those patients suffering from them.
Patients with cluster headaches -- severe headaches
occurring in clusters of several months and then receding -- have a higher
rate of anxiety disorders during the time between clusters of headaches, and
show memory deficits during headache clusters, according to a recent University
of Iowa Health Care study.
Ricardo Jorge, M.D., associate research scientist
in the UI department of psychiatry and lead author of the study, said the
impetus for the study was a previously identified link between migraines and
depression and anxiety. Cluster headaches, similar to migraines in many ways,
were thought to have a similar link, increasing the likelihood of patients
getting mood and anxiety disorders.
"If cluster headaches occur frequently with anxiety,
the headaches may cause the anxiety or the other way around," Jorge said.
"It is important to know the relationship between them so that doctors
may treat patients better."
Cluster headaches intense pain lasts 15 minutes
to an hour. This pain usually occurs over periods that last a few months.
After this time with multiple and severe attacks, the headaches disappear
for a long length of time and then begin again without warning.
The causes of cluster headaches are unknown but some
evidence suggests changes in blood flow in the brain and dysfunction in certain
brain areas. The incidence of cluster headaches is low, and cluster headaches
affect more men than women, at a ratio of as many as 7 to 1. These figures
may be somewhat misleading; doctors are increasingly diagnosing cluster headaches
in women, Jorge noted.
In the study, Jorge looked at a group of 21 patients
with varying degrees of cluster headaches at a headache unit in Buenos Aires,
Argentina and compared them with a group of patients with tension headaches
and milder pain. The patients in each group were tested with various psychiatric
measures as well as attention and memory tests.
The researchers found that five of the 21 cluster
headache patients met the criteria for anxiety disorder (panic disorder or
generalized anxiety disorder) in the year before the most recent cluster.
Only three of the patients with tension headache had any sign of a psychiatric
disorder. In addition, patients with cluster headaches showed lower scores
on tests of verbal memory during the headache period when compared to the
tension headache group.
"The findings on memory deficit, in particular,
were unexpected," Jorge said. "These types of headaches may be related
to dysfunction in a certain area of the brain, the same areas involved in
cognitive processing, and this may account for the memory impairments."
The association of cluster headaches and anxiety disorders
may also be related to brain dysfunction, especially certain areas known to
be involved in the development of mood and anxiety disorders, according to
There is no universal treatment for cluster headaches,
Jorge said, although many treatments may be divided into managing the headache
attack or decreasing the number of attacks during a cluster. Oxygen is often
used to alleviate the pain as it happens while other medications, including
lithium, are used to reduce the length of an episode.
While there may be a link between cluster headaches
and anxiety disorders, more work should be done before attempting to decide
how best to treat patients with both or who are likely to contract both, Jorge
"We need a bigger sample and then we will try
to replicate our findings. Then maybe we can see if any specific type of treatment
or approach is needed for those patients with cluster headaches and anxiety
disorders. We also need to further research the significance of the memory
disturbance involved with these headaches," Jorge said.
Jorge co-authored the study with Stephan Arndt, Ph.D.,
professor of psychiatry, and Robert G. Robinson, M.D., professor and head
of psychiatry. The study appeared in the Aug. 11 issue of the journal Neurology.
University of Iowa Health Care describes the partnership
between the UI College of Medicine and the UI Hospitals and Clinics and the
patient care, medical education and research programs and services they provide