Abstract
AIM: Headache is one of the most frequent somatic complaints in psychiatric practice and is often attributed to underlying mental disorders. However, primary headache disorders-particularly migraine and tension-type headache (TTH)-commonly coexist with psychiatric conditions. Evidence from psychiatric outpatient settings remains limited. METHODS: We conducted a retrospective chart review of all psychiatric outpatients who visited our 600-bed regional general hospital between April 1, 2023, and March 31, 2024. Among 2525 patients, we identified 360 individuals with headache-related insurance diagnoses and extracted data on headache labels, treating departments, and prescribed medications. For calcitonin gene-related peptide (CGRP)-targeted monoclonal antibodies, we extended the observation period to March 31, 2025, to describe an exploratory case series including additional prescriptions. RESULTS: Of 2525 psychiatric outpatients, 360 (14.3%) carried a headache-related insurance diagnosis. The most frequent labels were "headache" (203/360, 56.4%), migraine (92/360, 25.6%), and TTH (46/360, 12.8%); cluster headache and medication-overuse headache (MOH) were each recorded in 1/360 (0.3%). Headache care was most often delivered within psychiatry (153/360, 42.5%), followed by neurology (42/360, 11.7%), neurosurgery (40/360, 11.1%), general internal medicine (28/360, 7.8%), and rheumatology/collagen-vascular disease (15/360, 4.2%). Commonly documented agents included nonsteroidal anti-inflammatory drug (NSAIDs) (40/360, 11.1%), acetaminophen (38/360, 10.6%), triptans (23/360, 6.4%), Japanese Kampo formulas (16/360, 4.4%), and CGRP monoclonal antibodies (6/360, 1.7%). At the agent level, acetaminophen (n = 38), loxoprofen (n = 33), zolmitriptan (n = 14), goreisan (n = 8), sumatriptan (n = 6), kakkonto (n = 6), diclofenac (n = 4), valproic acid (n = 4), and naratriptan (n = 3) were among the most frequently listed. In the exploratory CGRP analysis (total seven patients through March 31, 2025), six were women; the mean age was 48.4 ± 9.2 years. Psychiatric comorbidities were heterogeneous, including eating disorder, bipolar disorder, post-traumatic stress disorder, dysthymia with social anxiety disorder, schizophrenia, autism spectrum disorder, and neurotic depression. All cases experienced headache improvement; two required switching to another CGRP agent for recurrent attacks yet maintained benefit. One patient temporarily discontinued due to a rash before resuming a different CGRP agent. In contrast, medium-term changes in mood/anxiety were limited. CONCLUSION: In a psychiatric outpatient cohort, primary headaches were common and frequently managed within psychiatry. CGRP-targeted therapy yielded headache relief even under psychiatric comorbidity, while psychiatric symptoms did not uniformly improve, underscoring the need for parallel mental-health interventions alongside headache-specific care. Strengthening cross-specialty pathways and early headache evaluation within psychiatry are warranted.