From the Guidelines
Adjustment disorder and headache should be managed simultaneously, focusing on stress reduction and lifestyle modifications to improve overall quality of life. Adjustment disorder can contribute to headaches through stress-related tension and anxiety. Treatment typically involves addressing both conditions simultaneously. For the adjustment disorder, cognitive behavioral therapy (CBT) sessions (8-12 weekly sessions) can help develop coping strategies, while selective serotonin reuptake inhibitors like sertraline (starting at 25-50mg daily, increasing to 50-200mg as needed) may be prescribed for 6-12 months in more severe cases 1.
Key Considerations
- For headaches, acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) can provide relief 1.
- Lifestyle modifications are essential:
- Practicing relaxation techniques (deep breathing, progressive muscle relaxation) for 15 minutes twice daily
- Maintaining regular sleep patterns (7-9 hours nightly)
- Staying hydrated (2-3 liters daily)
- Exercising moderately (30 minutes, 5 times weekly)
Management Approach
Identifying and managing specific stressors through journaling and setting boundaries can reduce both adjustment difficulties and associated headaches. This combined approach works because it addresses both the psychological stress triggering the adjustment disorder and the physical manifestation of that stress as headaches. According to a study published in the Mayo Clinic Proceedings 1, non-pharmacological therapies such as relaxation training, meditative therapy, and CBT can provide some relief for patients with chronic migraine. Exercise is also an important element in any disease-based management approach and should be encouraged.
Patient Empowerment
Patient empowerment through education, non-pharmacologic treatments, and establishing realistic expectations is key to improving quality of life in this underrecognized and undertreated population 1. By working together with the patient, healthcare providers can develop a comprehensive management plan that addresses both the adjustment disorder and headaches, ultimately improving the patient's overall quality of life.
From the Research
Adjustment Disorder and Headache
- Adjustment disorder is a common psychiatric disorder characterized by an extreme emotional reaction to a stressor 2
- The prevalence of adjustment disorder ranges from 0.2% to 40%, depending on the stressful circumstances that the patient experiences 2
- There are several treatments available for adjustment disorder, ranging from psychological interventions, natural therapies to pharmacotherapies 2
Treatment of Adjustment Disorder
- Psychotherapy seems indicated for mildly symptomatic adjustment disorder 3
- Pharmacotherapy interventions, such as benzodiazepines, antidepressants, or etifoxine, may be considered for adjustment disorder with severe symptoms 3
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been evaluated for the prevention of tension-type headache, but the evidence is limited 4, 5
Headache and Adjustment Disorder
- Tension-type headache is a common disorder that may be related to adjustment disorder 4
- SSRIs and SNRIs have been found to be no more effective than placebo in reducing headache frequency in patients with chronic tension-type headache 4, 5
- Tricyclic antidepressants may be more effective than SSRIs in reducing headache duration and intensity, but are associated with more adverse events 4, 5
Limitations of Current Evidence
- The quality of the evidence for positive effects of all psychological and pharmacological treatments on symptoms of adjustment disorder is ranked as low to very low 6
- Future high-quality research in the treatment of adjustment disorder has the potential to make a significant difference to individuals who struggle to recover after stressful events 6