Gesztelyi G, Bereczki D
Neurology and Headache Outpatient Clinic, City Health Service of Debrecen, Debrecen, Hungary.
Cephalalgia. 2005 Aug;25(8):598-604. doi: 10.1111/j.1468-2982.2005.00937.x.
Pain syndromes are often associated with depression. In a prospective study we analysed if determinants of depression differ among patients with different primary headaches and between headaches and non-headache pain. During a 2-year period between 1 February 2002 and 31 January 2004, 635 subjects (migraine n = 231; tension-type headache n = 176; cluster headache n = 11; patients with low back pain n = 103; and healthy subjects n = 114) seen by two neurologists filled in a questionnaire on pain characteristics, the MIDAS questionnaire and the Beck Depression Inventory. A multivariate general regression model was used to identify independent predictors of the severity of depressive symptoms. Pain was most frequent in chronic tension-type headache and most intense in the cluster subgroup (P < 0.001, Kruskal-Wallis ANOVA). In univariate tests gender, age, pain frequency, pain intensity and disability were all significantly associated with the severity of depressive symptoms. In the multivariate model disability was the most important independent determinant of the severity of depressive symptoms in the pooled headache group as well as in the migraine and tension-type headache subgroups. In contrast to patients with headache, pain frequency and pain intensity were the significant independent predictors of the severity of depressive symptoms in patients with low back pain. In a multivariate model, after controlling for other factors, determinants of the severity of depressive symptoms were different in headache and non-headache pain subjects, suggesting a different mechanism for developing depression in primary headaches and in other pain syndromes.
疼痛综合征常与抑郁症相关。在一项前瞻性研究中，我们分析了抑郁症的决定因素在不同原发性头痛患者之间以及头痛与非头痛性疼痛患者之间是否存在差异。在2002年2月1日至2004年1月31日的两年期间，两位神经科医生诊治的635名受试者（偏头痛患者n = 231；紧张型头痛患者n = 176；丛集性头痛患者n = 11；腰痛患者n = 103；健康受试者n = 114）填写了一份关于疼痛特征的问卷、偏头痛残疾评定量表（MIDAS）问卷和贝克抑郁量表。采用多变量一般回归模型来确定抑郁症状严重程度的独立预测因素。疼痛在慢性紧张型头痛中最为常见，在丛集性头痛亚组中最为剧烈（P < 0.001，Kruskal-Wallis方差分析）。在单变量测试中，性别、年龄、疼痛频率、疼痛强度和残疾程度均与抑郁症状的严重程度显著相关。在多变量模型中，残疾是合并头痛组以及偏头痛和紧张型头痛亚组中抑郁症状严重程度的最重要独立决定因素。与头痛患者不同，疼痛频率和疼痛强度是腰痛患者抑郁症状严重程度的显著独立预测因素。在一个多变量模型中，在控制了其他因素后，头痛和非头痛性疼痛受试者中抑郁症状严重程度的决定因素不同，这表明原发性头痛和其他疼痛综合征中发生抑郁症的机制不同。
