Anxiety and depressive disorders as predictors of ineffective treatment for dizziness and comorbid headaches

Dizziness and headache are the most common and maladaptive subjective complaints among outpatients. Their high prevalence, diagnostic difficulties due to the absence of obvious neurological symptoms, and significant social and economic consequences due to direct and indirect costs determined the relevance of this study. This article presents an analysis of factors contributing to the chronicity of functional dizziness and the reasons for the ineffectiveness of treatment measures. Experience in the diagnosis and successful treatment of dizziness, associated headaches, anxiety-depressive symptoms, and insomnia is presented.

Objective: to determine the frequency of comorbid pathology (migraine, tension type headache, affective disorders, and insomnia) in patients with persistent postural-perceptual dizziness (PPPD) and to identify the reasons for treatment failure in this patient cohort.

Materials and methods: The study included 119 patients aged 19 to 73 years with persistent postural-perceptual dizziness, the severity of which was assessed using the NPQ (Niigata Persistent Postural-Perceptual Dizziness Questionnaire). Before inclusion in the study, patients received vasoactive, neuroprotective and nootropic therapy due to persistent symptoms of dizziness. Patients were divided into 3 groups: the first group included patients with PPPD without comorbid headache, n=28 (23,.5%), the second group – with a concomitant diagnosis of episodic migraine, n=38 (32,.0%), the third – patients with a concomitant diagnosis of tension-type headache, n=53 (44.5%). All patients underwent clinical, neurological, ultrasound (duplex scanning of arteries and veins of the head and neck) and neuroimaging (MRI of the brain) examination. The HADS questionnaire (Hospital Anxiety and Depression Scale) was used to assess the severity of anxiety and depression.

Results: Brain MRI revealed Chiari malformation type 0-1 in 36.1% of patients. The highest incidence of this anatomical feature was found in the migraine group (44.7%), while the lowest incidence was found in the group without comorbid headache (17.9%), p < 0.05. Duplex scanning of the head and neck vessels revealed obstructed venous outflow from the cranial cavity in 58.0% of patients, with statistically significant differences between the groups without headache (28.6%) and with comorbid headache (78.9% in the group with comorbid migraine and 58.5% in the group with comorbid tension-type headache), p < 0.05. According to the HADS scale, anxiety was detected in 94.7% of patients before treatment (mean score 13.1), and depression in 68.4% (mean score 9.5). After comprehensive treatment (medication, including antidepressants, and psychotherapy), a significant reduction in the frequency and severity of anxiety (to 4.3 points, p < 0.05) and depression (to 2.4 points, p < 0.05) was noted. The severity of dizziness symptoms significantly regressed (from 38.3 points to 8.3 points on the NPQ, p < 0.05), and sleep quality improved.

Conclusion: This study allowed us to identify the comorbid pathology that caused the ineffectiveness of dizziness treatment and to develop optimal treatment strategies.