Headache, eating disorders, PTSD, and comorbidity: implications for assessment and treatment

Purpose 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. Methods 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 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). Conclusion 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. Level of evidence III Evidence obtained from well-designed cohort or case–control analytic studies.