A12. Headache attributed to psychiatric disorder

Headaches are commonly associated with various psychiatric disorders, but evidence of a causal relationship is lacking for most. The following are offered as candidate criterion sets to facilitate research into the possible causal relationships between certain psychiatric disorders and headache. It is not recommended that they be used routinely in clinical practice to describe the association between comorbid headache and psychiatric disorders. In the vast majority of cases, headache associated with these disorders most probably reflects common underlying risk factors or aetiologies.

In order to make any of the diagnoses listed below, it is crucial to establish a causal relationship between the headache and the psychiatric disorder in question. Thus, either the headache onset occurs simultaneously with the psychiatric disorder or the headache clearly worsens after the psychiatric disorder becomes evident. Definite biomarkers and clinical proof of headache causation are difficult to obtain, and the diagnosis should be based on high levels of clinical suspicion. Thus, for example, in a child with separation anxiety disorder, headache should be attributed to this disorder only in those cases where it occurs solely in the context of actual or threatened separation, without any better explanation. Similarly, in an adult with panic disorder, headache should be attributed to the disorder only in those cases where it occurs solely as one of the symptoms of a panic attack.