Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
Timothy D. Brewerton, MD, LLC, Mt. Pleasant, SC, USA.
Eat Weight Disord. 2022 Oct;27(7):2693-2700. doi: 10.1007/s40519-022-01414-6. Epub 2022 May 23.
Severe headaches (HAs) have been associated with eating disorders (ED) as well as with trauma, posttraumatic stress disorder (PTSD), major depression and anxiety. However, data addressing all of these factors in the same subjects are limited.
In a large sample of patients (n = 1461, 93% female) admitted to residential treatment (RT) for an ED, we assessed within 48-72 h of admission subjective reports of frequent HAs and their associations with severity of ED, PTSD, major depressive and state-trait anxiety symptoms, as well as quality of life measures. HA ratings were significantly correlated to the number of lifetime trauma types as well as to symptoms of PTSD, major depression, and state-trait anxiety.
Results indicated that 39% of patients endorsed that frequent HAs occurred "often" or "always" (HA+) in association with their eating or weight issues. This HA-positive (HA+) group had statistically significant higher numbers of lifetime trauma types, higher scores on measures of ED, PTSD, major depressive, and state-trait anxiety symptoms, and worse quality of life measures (p ≤ 0.001) in comparison to the HA-negative (HA-) group, who endorsed that frequent HAs occurred "never," "rarely," or "sometimes" in association with their eating or weight issues. The HA + group also had a significantly higher rate of a provisional PTSD diagnosis (64%) than the HA- group (35%) (p ≤ .001). Following comprehensive RT, HA frequency significantly improved (p ≤ .001).
These findings have important implications for the assessment and treatment of HAs in the context of ED, PTSD and related psychiatric comorbidities, especially at higher levels of care. In addition, the importance of identifying traumatic histories and treating comorbid PTSD and related psychopathology in individuals presenting with severe HAs is emphasized.
III Evidence obtained from well-designed cohort or case-control analytic studies.
严重头痛(HA)与饮食失调(ED)以及创伤、创伤后应激障碍(PTSD)、重度抑郁症和焦虑症有关。然而,在同一组患者中,涉及所有这些因素的数据有限。
在接受住院治疗(RT)治疗 ED 的大量患者样本(n=1461,93%为女性)中,我们在入院后 48-72 小时内评估了频繁 HA 的主观报告及其与 ED 严重程度、PTSD、重度抑郁和状态-特质焦虑症状以及生活质量测量的相关性。HA 评分与既往创伤类型的数量以及 PTSD、重度抑郁和状态-特质焦虑的症状显著相关。
结果表明,39%的患者表示频繁 HA“经常”或“总是”(HA+)与他们的饮食或体重问题有关。与 HA-组相比,HA 阳性(HA+)组的既往创伤类型数量显著增加,ED、PTSD、重度抑郁和状态-特质焦虑症状的评分更高,生活质量测量更差(p≤0.001),他们表示频繁 HA“从未”、“很少”或“有时”与他们的饮食或体重问题有关。HA+组的临时 PTSD 诊断率(64%)也明显高于 HA-组(35%)(p≤0.001)。在接受全面 RT 治疗后,HA 频率显著改善(p≤0.001)。
这些发现对 ED、PTSD 及相关精神共病情况下 HA 的评估和治疗具有重要意义,尤其是在更高水平的护理中。此外,强调了识别创伤史和治疗伴有严重 HA 的个体共病 PTSD 和相关精神病理学的重要性。
III 级 来自精心设计的队列或病例对照分析研究的证据。