原发性头痛患者伴发焦虑、抑郁障碍的临床研究

Clinical study of primary headache complicated with anxiety and depression disorder

目的分析原发性头痛患者中焦虑、抑郁的发生情况及其影响因素。方法收集2013年10月～2015年10月来我院神经内科门诊就诊的以头痛为主诉的首诊患者,根据国际原发性头痛诊断标准入选偏头痛或紧张型头痛病例。所有入选患者均先行颅脑CT或MRI检查,然后对性别、年龄、职业、收入状况、学历、病程进行登记,并应用汉密尔顿焦虑和抑郁量表进行焦虑、抑郁评定。结果 1共收集原发性头痛患者596例,323例患者伴发焦虑、抑郁障碍,发生率为54.2%,其中偏头痛患者焦虑、抑郁障碍的发生率为51.1%,紧张型头痛患者的发生率为60.4%,两者差异有统计学意义（χ2=4.574,P=0.032）。2女性、无业、低学历、低收入、病程≥1年的原发性头痛患者焦虑、抑郁的发生率显著高于男性、在职、高学历、高收入、病程〈1年的患者,差异有统计学意义（χ2=6.576,P=0.010;χ2=20.579,P=0.001;χ2=5.610,P=0.018;χ2=11.946,P=0.001;χ2=12.571,P=0.000）。结论原发性头痛患者常伴有焦虑、抑郁,在诊疗过程中应注意焦虑、抑郁的伴发情况,尤其是女性、无业、低学历、低收入、病程〉1年的患者。

Objective To analyze the incidence of anxiety and depression in the patients with primary headache admitted to the outpatient clinic of neurology and their influencing factors. Methods The patients who were firstly admitted to the outpatient clinic of neurology in our hospital with the complaint of headache from October 2013 to October 2015 were continuously collected.According to the international diagnosis criteria for primary headache,cases of migraine or tension headache were included.All included patients were given cranial CT or MRI first.Afterwards,patients＇ gender,age,occupation,income,educational background and course of disease were registered,and Hamilton Depression Scale（HAMD） was applied for the determination of anxiety and depression. Results 1 596 patients with primary headache were collected,among whom 323 patients were complicated with anxiety and depression disorder,with the incidence rate of 54.2%.The incidence rate of anxiety and depression disorder in the patients with migraine was 51.1%,and its incidence rate in the patients with tension headache was 60.4%.The difference between the two was statistically significant（χ2=4.574,P=0.032）.2The incidence rate of anxiety and depression disorder in the patients with primary headache who were female,unemployed,poorly educated,had low income and the course of disease over 1 year was significantly higher than that in male patients,employed patients,well-educated patients,patients with high income and patients with the course of disease ≤1 year,the differences were statistically significant（χ2=6.576,P=0.010;χ2=20.579,P=0.001;χ2=5.610,P=0.018;χ2=11.946,P=0.001;χ2=12.571,P=0.000）. Conclusion The patients with primary headache are usually complicated with anxiety and depression.Attention should be paid to complicated symptoms during treatment and diagnosis,especially for female patients,unemployed patients,poorly educated patients,patients with low income and patients with the course of disease over 1 year.