A Risal 1, 2, K Manandhar1, 2, A Holen1,3, TJ Steiner 1, 4, M Linde1,3 Lifting The Burden in Official Relations with the World Health Organization The Global Campaign against Headache COMORBIDITIES OF PSYCHIATRIC AND HEADACHE DISORDERS IN NEPAL: IMPLICATIONS FROM A NATIONWIDE POPULATION-BASED STUDY A Risal 1, 2, K Manandhar1, 2, A Holen1,3, TJ Steiner 1, 4, M Linde1,3 1. Norwegian University of Science and Technology, Trondheim, Norway; 2. Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal; 3. St Olavs University Hospital, Trondheim, Norway; 4. Imperial College London, London, UK Background Headache disorders, anxiety and depression, the major disorders of the brain (MDBs), are highly comorbid in Western countries. Whether this is so in South Asia has not so far been investigated. Aim To examine associations between headache disorders (migraine, tension-type headache [TTH] and headache on ≥15 days/month) and psychiatric conditions (anxiety, depression and neuroticism), and their effects on quality of life (QoL), in Nepal. Method In a nationwide, cross-sectional survey of the adult population (N=2,100), trained interviewers applied culturally-adapted Nepali versions of : 1) HARDSHIPa to diagnose headache disorders; 2) HADSb to detect anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD); 3) EPQRS-Nc to assess neuroticism; and 4) WHOQOL-8d to assess QoL. Associations with headache types were analyzed using logistic regression for psychiatric caseness and linear regression for neuroticism. Results Bidirectional relationships existed between migraine and headache on ≥15 d/m on one hand and HADS-A and HADS-cAD on the other (Table 1). Headache and neuroticism were similarly associated (Table 2). In both analyses, exceptions were TTH and HADS-D. a Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation; b Hospital Anxiety and Depression Scale; c Eysenck Personality Questionnaire Revised Short Form-Neuroticism; d World Health Organization Quality of Life 8-question scale However, significant additive effects of psychiatric comorbidity on different headache types were evident; QoL scores were reduced in all headache types when comorbid with HADS-caseness (Table 3). Headache type   HADS-A (N=340) HADS-D (N=109) HADS-cAD (N=137) No headache (N=306) reference Any headache (N=1,794) 1.6 [1.1–2.3] 1.2 [0.6–2.0] 1.9 [1.0–3.6] Migraine (N=728) 1.7 [1.1–2.6] 1.3 [0.7–2.3] 2.3 [1.2–4.4] TTH (N=863) 1.3 [0.8–1.9] 0.9 [0.5–1.8] 1.4 [0.7–2.8] Headache on ≥15 d/m (N=161) 3.2 [1.9–5.4] 1.5 [0.6–3.4] 2.7 [1.2–6.1] Table 1. Logistic regression analysis (AORs with 95% CIs) showing associations of headache disorders with HADS-defined psychiatric caseness; adjusted for age, gender, annual household consumption, habitation, altitude and use of alcohol and marijuana Headache type B [95% CI] p No headache (N=306) reference Any headache (N=1,794) 0.9 [0.5-1.2] <0.001 Migraine (N=728) 1.3 [0.8-1.7] TTH (N=863) 0.4 [0.2-0.8] 0.040 Headache on ≥15 d/m (N= 161) 1.6 [0.9-2.2] Table 2. Linear regression analysis (coefficient B with 95% CI) showing associations of headache disorders with neuroticism; adjusted for the same variables Headache type HADS-A (N=340) HADS-D (N=109) HADS-cAD (N=137) + - p Migraine (N=728) 25.7 ±4.1 26.9 ±3.9 <0.001 24.6 ±2.9 22.7 ±3.6 27.1 ±3.7 TTH (N=863) 27.2 ±3.8 28.4 24.9 ±3.2 24.4 Headache on ≥15 d/m (N=161) 25.1 ±4.2 26.2 0.10 24.0 25.9 0.11 21.6 ±3.4 26.4 Table 3. Quality of life (mean WHOQOL scores ± SD) by headache type, with and without comorbid psychiatric caseness; analysis by Student’s t-test Conclusions Headache disorders are strongly associated with anxiety and neuroticism in Nepal. This calls for reciprocal awareness among policy makers and among health-care providers in each discipline to offer coordinated management of these common comorbid disorders. Risal A, Manandhar K, Holen A, Steiner TJ, Linde M (2016) Comorbidities of psychiatric and headache disorders in Nepal: implications from a nationwide population-based study. J Headache Pain 17: 45.