To study types, pattern and distribution of headache associated with depression and its effect on daily activity. Selected 50 patients who had diagnosed on DSM-IV-TR & ICD-10 criteria for depression and had >9 score on HAMD. The structured questionnaire applied to investigate types, patterns and distribution, daily work loss and associated somatic symptoms. The most common pattern of distribution of headache is bilateral temporal (40%) followed by whole scalp and unilateral. The mode of onset is sudden (86%) , pulsatile (98%) due to poor early recognition of headache in low socio economic group. It is only recognized when pulsation begins after enough accumulation of toxic metabolites (trigemino vascular system). Headache affects daily activity; most common duration of work loss is 1-3 hours and least 2-3 days due to episodic nature of headache. Band like headache is the initial features of headache in depression but it is less reported seen only in 2% Most of the presentation are .Pulsatile Headache and migraine in 26% .These were late and waited till the conversion of band like (less recognizable ) into pulsatile headache ( more recognizable ). The different types of headache migraine, tension headache and cluster headache have same genesis pathways shared by depression or has bidirectional effect. Depression was an accidental finding for which they did not come to clinic .Depression remains as an iceberg.
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