Study Suggests Benefit to Integrating Care for Migraine, Depression

AJMC Staff

A recent study examined associations of comorbid migraine with other painful physical symptoms (PPS) in patients with major depressive disorder (MDD) at 2 years, and results suggested there might be benefit to integrating care for those with both depression and headache.

Mood disorders and migraines are associated, and the authors hypothesized that patients with and MDD migraine may still have greater severities of PPS at the 2-year follow-up point. Other research has found that patients with migraine were associated with increased other PPS.

This study was conducted from September 2005 to August 2009 in the psychiatric outpatient clinics of the Chang Gung Memorial Hospital, a medical center in northern Taiwan. At baseline, 155 outpatients with MDD were enrolled. Migraine was diagnosed at baseline according to the International Classification of Headache Disorders.

Four exclusion criteria were used to prevent depression and PPS from being confounded: (1) any antidepressant treatment or other psychotropic drug treatment within the previous month; (2) severe psychomotor retardation, psychotic features, or catatonic features;( 3) chronic medical diseases such as hypertension, diabetes mellitus, and other medical diseases, except headaches; and (4) a history of substance abuse and/or dependence without full remission in the past month.

At follow-up, 101 subjects were analyzed.

The average intensities of head, bone and/or joints, back, chest, abdomen, neck and/or shoulder, general muscle, and limb pain in the past week were evaluated using a visual analog scale (VAS). Active headache was defined as a score on the VAS greater than 3. Multiple linear regressions were used to investigate the associations of migraine at baseline with other PPS at follow-up.

Patients with migraine with active headache had significantly higher intensities of other PPS and a lower remission rate of depression, compared with patients who had migraine with inactive headaches and those without migraine.

There were no significant differences in the pain intensities of the other 7 PPS between the migraine with inactive headache group and the nonmigraine group. Headache intensity was significantly correlated with the intensities of other PPS at baseline and follow-up.

The researchers said that migraine with active headache independently predicted other PPS after controlling for depression and anxiety at baseline.

Prevention and treatment of headache might help to decrease other PPS and improve the prognosis of depression, the researchers said.

Hung CI, Liu CY, Yang CH, Wang SJ. Migraine with active headache was associated with other painful physical symptoms at two-year follow-up among patients with major depressive disorder [published online April 30, 2019]. PLoS One. doi: 10.1371/journal.pone.0216108.
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