Early maladaptive schemas in patients with chronic headache

Background: Chronic headache is a serious clinical problem in women which psychological factors play major role and requires an approach with bio-psycho-social integrity. Psychiatric comorbidities such as anxiety disorder and major depression are frequent. Young described Early Maladaptive Schemas (EMS) as maladaptive and dysfunctional patterns that appear due to unpleasant situations occurred between patient and people who were important to him. EMSs affect perception, emotions, thoughts and behaviors that makes a basis for many disorders. EMSs are found to be related with depression, anxiety and somatization within recent literature. There is a lack of data about the relationship between EMSs and migraine (MH) and tension-type headache (TTH). Our study directly compared three groups, migraine and tension type headache and healthy controls. Methods 150 female patients with chronic headache were enrolled for study in consecutive fashion. Exclusion criteria were as follows: age  60 years, male gender, existence of comorbidity affecting central nervous system, headache due to drug/substance abuse, previous diagnosis of migraine with aura, previous diagnosis of psychotic disease, mental retardation, cognitive disorders, being in delirium state. Patients were grouped into two categories according to type of headache and a third control group. All patients were evaluated with Young Schema Questionnaire (YSQ) and their scores were noted and categorized in related schema domains. Results Sociodemographic data were comparable among groups. However, there were significant differences in terms of previous psychiatric diagnosis and psychiatric drug usage. When we compared YSQ scores, groups differed in many schema categories. MH group showed significantly higher scores in dependency/incompetency, unrelenting standards and punitiveness schemas when compared to remaining two groups. TTH group had significantly more points in emotional deprivation, vulnerability to harm or illness schemas among all groups. On the other hand, control group had significantly higher scores in insufficient self-discipline and entitlement/grandiosity schemas when compared to both MH and TTH groups. Conclusion Presence of EMSs in female patients with headache significantly differed from control group. Types of early maladaptive schemas were also significantly different between patients with MH and TTH among this whole headache group.