Doctor, can one see worms in a scan? Clinical case of headache attributed to psychotic disorder

Abstract

Background:

The International Classification of Headache Disorders (2nd. Edition) recognizes, among headaches secondary to psychiatric disorders, the relatively rare ones attributed to psychotic disorders.

The Delusion of Infestation has unknown prevalence. It may occur at any stage, but is more frequent in senior individuals. The rate male-female is 1:1 and 3:1 before and after 50 years old, respectively. The diagnostic classification reveals a great rate of “pure forms” (Delusional Disorder according to DSM-IV or ICD-10), but the syndrome was also described in Schizophrenia, Affective or Organic Psychosis, or even as a neurotic symptom.

The present report describes the case of one 56 years-old woman admitted to a psychiatric ward due to a Delusion of Infestation. This condition was evolving for several years with the occurrence of both visual and coenaesthetic hallucinations. Complaints were of severe unspecific headaches with delusional believes about its aetiology (brain infestation). No alterations were detected after an organic medical examination. She started antipsychotic and antidepressive medication, with consequent decrease of the delusions. The patient is currently in recovery, referring reduced pain and no delusion ideation.

Aim:

To describe a clinical case of headache secondary to Delusion of Infestation.

Material and Methods:

Clinical file review, bibliographic review.