Functional neurological disorders (FND), which encompass FMD, are complex conditions frequently associated with comorbidities such as migraine and other headache disorders. A deeper understanding of the association between headaches and neuropsychological interplay in FMD patients may illuminate an insightful, comprehensive approach to management.

We retrospectively collected data of all (30) patients seen in our FMD IDC since its inception. The following factors were analyzed via Pearson correlation coefficient for an association with headache: FMD phenotype, baseline symptom severity (CGI-S), anxiety (GAD-7), somatic symptoms (PHQ-15), depression (PHQ-9), subjective cognitive symptoms (SCD), sex, ethnicity, patient global impression of improvement (PGI-I), and clinical global impression of improvement (CGI-I). Pairwise deletion corrected for any missing data.

Of 30 analyzed FMD patients, 19 (63%) were female and 19 (63%) experienced self-reported headache. There was no significant association between gender and reported headache. We found a statistically significant positive correlation between headache and depression (R=0.43, p=0.03) and between headache and anxiety (R=0.33; p=0.08). There was an insignificant correlation between headache and somatic symptoms (R=0.24, p=0.22) and subjective cognitive symptoms (R=0.15, p=0.43). PGI-I and CGI-I outcome data was available for 12 patients post-FND treatment; report of headache at baseline did not significantly impact perceived improvement (PGI/CGI-I scores <4). 

Most FMD IDC patients reported experiencing headache, which was positively correlated with comorbid mood disorders, particularly depression, cognitive complaints, and other somatic symptoms. This trend underscores gaps in existing holistic management of psychosomatic burden in FMD headache patients. We encourage further research focusing on phenotyping headache in an FMD population and developing targeted headache treatment approaches in FMD to achieve functional symptomatic recovery.