Volume-1 Issue-3 September, 2011
Consultation Liaison Psychiatry Focus: Otorhinolaryngology
Headache is not new to anybody, in fact I had one yesterday, which subsided with a small nap! Well most of
the people suffer from headache one day or the other, so it won’t be surprising that this symptom is taken very lightly
by the people. Only when the symptom is unbearable or does not subside with analgesics, the patients would approach a doctor. Available literature says that most of the patients with unexplained headache do have a cause which is not properly evaluated.
Headache can be due to recognizable causes like tension headache, cluster headache, sinusitis, migraine,
thunderclap headache, temporal arteritis, ophthalmic causes like glaucoma. Headache due to sinus disease usually
follows a rhinitis or secondary to toothache and usually localised and easily diagnosed by radiological investigations.
Cluster headache usually occurs in early morning, will be unilateral, dull aching and responds spontaneously to
analgesics. Migraine usually presents as a unilateral pulsating headache aggravated by movement and associated with
nausea and photophobia, triggers being sleep deprivation or caffeine usage or fasting. Thunderclap headache occurs
following exertion or sexual activity and presents as a sharp agonising pain, but subsides spontaneously without
medication. Temporal arteritis usually manifests as a localised temporal headache, occasionally associated with visual
symptoms and has good response to steroids. Ophthalmic causes of headache like glaucoma present as throbbing pain around the eyes which can be confirmed by tonometry. It should also be noted that most of these conditions have high rates of co-morbid Psychiatric diagnosis especially those associated with Migraine.
When the doctor feels that the patient’s symptoms are not corroborating with the associated signs known to
him or the symptoms do not subside with well planned management, the suspicion of a non-organic cause should be
explored. This is where awareness of common psychiatric disorders comes into picture. Many psychiatric disorders like
depression with typical early morning headache, somatisation disorder with multiple complaints & numerous
consultations, anxiety disorders, interpersonal problems, do present with headache or heaviness of head.
The diagnosis of a psychiatric disorder cannot be made only on the basis of non-organic headache, but should
be considered with other symptoms. So cross consultation with the psychiatrist should be a smooth affair, because the
word psychiatrist rings many bells in Indian society, particularly with respect to stigma. The patient should be
educated that opinion from psychiatrist may ease his headache without the use of unnecessary medications and investigations. Hence it should also be wise to address co-morbid psychiatric conditions while taking a
detailed history and in management of organic causes of headache.
Assistant Professor of ENT, AIMS
