I have had injured workers who complain of severe headaches and say they cannot work. Often these individuals have had no head injury. The neurologists seem to feel the headaches are disabling.
There is an article in the journal Headache with a lengthy discuss of depression and anxiety as being among the psychological symptoms that accompany frequent headache and headache-associated disability.
The presence of psychological comorbidity (that is, concurrent anxiety and depression as well as headache) with headache predicts a longer lifetime duration of headache and a poorer prognosis for headache reduction.
Subjects who had headaches more than 4 days a week and those with headache-associated activity limitation for 3 or more days a week showed significantly greater depression and anxiety.
Anxiety and depression were not believed to result from or cause the headaches but to co-exist in many headache sufferers.
These symptoms were not directly associated with headache severity. However, compared with typically mild or moderate headache, severe headache was associated with reductions in role and social functioning.
Frequent headache and frequent headache-associated disability were also linked to reduced quality of life in areas including physical and social functioning.
The article concluded that that patients with such symptoms “should be further evaluated for the presence of psychological disturbance. Headache 2000;40:373-376.