Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct;27(7):2693-2700.
doi: 10.1007/s40519-022-01414-6. Epub 2022 May 23.

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

Timothy D Brewerton  1   2   3 , Molly M Perlman  4   5 , Ismael Gavidia  4 , Giulia Suro  4 , Joel Jahraus  4
Affiliations

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

Timothy D Brewerton et al. Eat Weight Disord. 2022 Oct.

Abstract

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.

Keywords: Comorbidity; Depression; Eating disorders; Headache; PTSD; Trauma.

PubMed Disclaimer

References

    1. George MS, Brewerton TD, Harden RN (1993) Bulimia nervosa in outpatients with migraine: a pilot study. J Nerv Ment Dis 181:704–706 - PubMed - DOI
    1. Brewerton TD, George MS (1993) Is migraine related to the eating disorders? Int J Eat Disord 14:75–79 - PubMed - DOI
    1. Brewerton TD, George MS, Harden RN (1993) Migraine and the eating disorders. Psychiatry Res 46:201–202 - PubMed - DOI
    1. Ostuzzi R, D’Andrea G, Francesconi F, Musco F (2008) Eating disorders and headache: coincidence or consequence? Neurol Sci 29(Suppl 1):S83-87 - PubMed - DOI
    1. D’Andrea G, Ostuzzi R, Francesconi F, Musco F, Bolner A, d’Onofrio F, Colavito D (2009) Migraine prevalence in eating disorders and pathophysiological correlations. Neurol Sci 30(Suppl 1):S55-59 - PubMed - DOI

MeSH terms

LinkOut - more resources