Depression Is Associated With Transformation of Episodic to Chronic Migraine

Data suggest that depression may have a dose-dependent effect on the risk of transformation from episodic migraine to chronic migraine.



Depression is associated with an increased risk of progression to chronic migraine among patients with episodic migraine, according to research published in the September 25 Journal of Headache Pain. The manuscript received the 2012 Enrico Greppi Award endorsed by the European Headache Federation and the Italian Society for the Study of Headaches. The association was significant after adjusting for variables such as sociodemographic features, headache features, other comorbidities, allodynia, use of antidepressants and medication overuse, said Sait Ashina, MD, Assistant Professor of Neurology at the Albert Einstein College of Medicine in Bronx, New York, and colleagues.

The risk of transformation to chronic migraine also increased with the severity of depression, even after adjusting for covariates. Patients with moderate, moderately severe, or severe depression had significantly higher rates of transition than patients with mild or no depression.

Dr. Ashina’s group examined data from the American Migraine Prevalence and Prevention study to determine whether depression reliably predicted the new onset of chronic migraine among patients with episodic migraine. The study sample included 8,078 patients who had episodic migraine in 2005, 2006, or both. All patients provided follow-up data in response to questionnaires in 2006 and 2007.

Migraine was defined according to criteria based on those of the International Classification of Headache Disorders-2. Depression was measured with the Patient Health Questionnaire-depression module and with self-reported physician diagnosis. Patients’ depression was categorized as none or minimal, mild, moderate, moderately severe, or severe.

Patients with episodic migraine and depression had an odds ratio of 1.65 for new-onset chronic migraine after adjusting for covariates. Moderately severe depression was associated with a 1.82 odds ratio of new-onset chronic migraine, and severe depression correlated with a 1.81 odds ratio of new-onset chronic migraine, after adjusting for covariates.

“The specific mechanisms linking these conditions and the explanation for the chronification of migraine remain uncertain,” Dr. Ashina told Neurology Reviews. “Treating clinicians must search for depression in patients with episodic migraine. “Depression must be addressed as a separate problem in these patients and treated accordingly. Future studies should determine if treating depression will reduce the risk of chronification of migraine.”

—Erik Greb

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