Study Suggests Integrating Migraine and Depression Treatment

Alison Rodriguez

Pain symptoms and depression are often linked and previous reports have suggested shared genetic mechanisms between major depressive disorder (MDD) and migraine. A recent study investigated the associations of migraine with pain symptoms among outpatients with MDD during a 10-year period, finding that migraine treatment should be integrated into treatment for depression to improve patients’ pain symptoms and health-related quality of life (HRQoL).

The study, published in The Journal of Headache and Pain, included 290 outpatients with MDD at baseline. The patients also had follow-up at 6 months, 2 years, and 10 years. The researchers used the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, for the diagnoses of MDD and anxiety comorbidities, while migraine was diagnosed using the International Classification of Headache Disorders.

“Nearly half of patients with MDD have comorbid migraine. MDD patients with migraine have greater severities of depression, anxiety, and pain symptoms than those without migraine,” noted the researchers.

In order to quantify the pain symptoms, the researchers used the bodily pain subscale of the Short Form 36 (SF-BP) and the pain subscale (PS) of the Depression and Somatic Symptoms scale. During each follow-up, each patient was assessed for headaches, anxiety comorbidities, pain, and depression.

The results suggested that patients with MDD with migraine had lower SF-BP and higher PS scores than those without migraine. Additionally, depression, anxiety, and headache indices were found to be significantly correlated with SF-BP and PS scores. For migraine, the researchers found the higher the frequency of migraine, the more often the patients suffered from pain symptoms.

Those who had migraine during all follow-up periods were found to have suffered from pain most of the time (60% to 73.7%) over the 10-year period. When controlled for depression and anxiety, migraine was found to be independently associated with a decreased SF-BP score and an increased PS score.

“Migraine prevention should be integrated into the treatment of depression, because simultaneous treatment of depression and migraine might help to improve pain symptoms and the score in the pain dimension of the HRQoL,” concluded the authors. “Physicians should employ therapeutic strategies, including pharmacotherapy, cognitive behavioral therapy, and relaxation techniques, for the simultaneous treatment of depression and migraine.”

The study concluded that migraine and depression should be treated together due to their relation among patients. The researchers also noted the need for further research to support the hypothesis that improving pain symptoms may decrease depressive symptoms among those with depression.

Hung CI, Liu CY, Yang CH, Wang SJ. Migraine and greater pain symptoms at 10-year follow-up among patients with major depressive disorder. J Headache Pain. 2018;19(1):56. doi: 10.1186/s10194-018-0884-9.
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