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Diagnostic criteria:

  1. Headache, no typical characteristics known, fulfilling criteria C-E
  2. Presence of major depressive disorder fulfilling DSM-IV criteria:
    1. one or more episodes in which, during the same 2-week period, at least five of the following symptoms are present:
      • depressed mood
      • markedly diminished interest or pleasure
      • weight or appetite change
      • insomnia or hypersomnia
      • psychomotor agitation or retardation
      • fatigue or loss of energy
      • feelings of worthlessness or excessive or inappropriate guilt
      • diminished ability to concentrate or indecisiveness
      • recurrent thoughts of death, suicidal idea, plan or attempt
    2. occurring in the absence of any manic or hypomanic episodes
    3. not better accounted for by bereavement and not due to the direct physiological effects of a medical condition or substance
  3. Headache occurs exclusively during major depressive episodes
  4. Headache resolves or greatly improves within 3 months after the major depressive disorder is in full remission
  5. Headache is not attributed to another cause

Comment:

Since tricyclic antidepressants are effective against certain types of headache, remission of headache is more suggestive of a psychiatric cause of the headache when major depressive disorder improves under treatment with other antidepressants than tricyclic antidepressants.