2009 Southern Regional Meeting Abstracts

Purpose of Study: Headache is the sixth most common presenting complaint in ambulatory clinics in El Salvador. Previous studies have linked depression to functional somatic syndromes including tension type headaches. The aim of this study was to determine the frequency and severity of depressive symptoms in patients with tension headaches and its relationship with the subtypes of tension type headaches in a rural clinic in El Salvador.
Methods Used: Patients diagnosed with tension type headache based on International Headache Society (IHS) criteria in La Palma, El Salvador were first classified as chronic or episodic. Demographic and clinical data were collected and recorded in a structured format. A validated translation of Zung's Self-rating Depression Scale (SDS) was administered to each subject to determine the presence and severity of depression. Depression severity was divided into 4 categories per SDS guidelines: normal (score < 50), mild depression (score 51-59), moderate (score 60 - 69), and severe depression (score >70). Odds ratios (OR) were then calculated based on demographic variables, headache subtype and depression severity and p values calculated.
Summary of Results: We evaluated 146 consecutive patients with tension type headache. Forty-six either declined to participate or met exclusion criteria. The final sample of 100 patients consisted of 91 women ranging in age from 15 to 71 and 88% were from rural areas. Fifty-two percent of the patients had chronic tension headaches and 48% had episodic. Depression was present in 84% of the sample overall. Depressive symptoms were present more frequently in patients with the chronic subtype of headaches compared with patients with the episodic subtype (OR: 10.29; CI 2.02 - 70.2). The mean SDS scores were higher in patients with the chronic subtype (58.6) compared with the episodic subtype (46.2).
Conclusions: Patients in this rural El Salvadoran clinic with the chronic subtype of tension headache were more likely to have depressive symptoms and their depression was more severe compared with patients with the episodic subtype of tension headaches. This study highlights the importance of recognizing tension type heachaches as a possible functional somatic symptom of an underlying depressive disorder.