Aim:Headache is one of the most frequent somatic complaints in psychiatric practice and is often attributed to underlying mental disorders. However, primary headache disorders—particularly migraine and tension‐type headache (TTH)—commonly coexist with psychiatric conditions. Evidence from psychiatric outpatient settings remains limited.
Methods:We conducted a retrospective chart review of all psychiatric outpatients who visited our 600‐bed regional general hospital between April 1, 2023, and March 31, 2024. Among 2525 patients, we identified 360 individuals with headache‐related insurance diagnoses and extracted data on headache labels, treating departments, and prescribed medications. For calcitonin gene–related peptide (CGRP)‐targeted monoclonal antibodies, we extended the observation period to March 31, 2025, to describe an exploratory case series including additional prescriptions.
Results:
Of 2525 psychiatric outpatients, 360 (14.3%) carried a headache‐related insurance diagnosis. The most frequent labels were “headache” (203/360, 56.4%), migraine (92/360, 25.6%), and TTH (46/360, 12.8%); cluster headache and medication‐overuse headache (MOH) were each recorded in 1/360 (0.3%). Headache care was most often delivered within psychiatry (153/360, 42.5%), followed by neurology (42/360, 11.7%), neurosurgery (40/360, 11.1%), general internal medicine (28/360, 7.8%), and rheumatology/collagen‐vascular disease (15/360, 4.2%). Commonly documented agents included nonsteroidal anti‐inflammatory drug (NSAIDs) (40/360, 11.1%), acetaminophen (38/360, 10.6%), triptans (23/360, 6.4%), Japanese Kampo formulas (16/360, 4.4%), and CGRP monoclonal antibodies (6/360, 1.7%). At the agent level, acetaminophen (
n
= 38), loxoprofen (
n
= 33), zolmitriptan (
n
= 14), goreisan (
n
= 8), sumatriptan (
n
= 6), kakkonto (
n
= 6), diclofenac (
n
= 4), valproic acid (
n
= 4), and naratriptan (
n
= 3) were among the most frequently listed. In the exploratory CGRP analysis (total seven patients through March 31, 2025), six were women; the mean age was 48.4 ± 9.2 years. Psychiatric comorbidities were heterogeneous, including eating disorder, bipolar disorder, post‐traumatic stress disorder, dysthymia with social anxiety disorder, schizophrenia, autism spectrum disorder, and neurotic depression. All cases experienced headache improvement; two required switching to another CGRP agent for recurrent attacks yet maintained benefit. One patient temporarily discontinued due to a rash before resuming a different CGRP agent. In contrast, medium‐term changes in mood/anxiety were limited.
Conclusion:In a psychiatric outpatient cohort, primary headaches were common and frequently managed within psychiatry. CGRP‐targeted therapy yielded headache relief even under psychiatric comorbidity, while psychiatric symptoms did not uniformly improve, underscoring the need for parallel mental‐health interventions alongside headache‐specific care. Strengthening cross‐specialty pathways and early headache evaluation within psychiatry are warranted.