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Migraine with Active Headache in Patients with MDD

Among patients with major depressive disorder (MDD), migraine with active headache could predict other painful physical symptoms (PPS), a new study found. At baseline, 155 outpatients with MDD were enrolled. At follow-up, data of 101 participants 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. Researchers found:

  • Compared with the migraine with inactive headache group and the non-migraine group, patients with migraine and active headache had significantly higher intensities of other PPS and a lower remission rate of depression.
  • There were no significant differences in the pain intensities of the other 7 PPS between the migraine with inactive headache group and the non-migraine group.
  • Headache intensity was significantly correlated with the intensities of other PPs at baseline and follow-up.


Hung CI, et al. Migraine with active headache was associated with other painful physical symptoms at two-year follow-up among patients with major depressive disorder. [Published online ahead of print April 30, 2019]. PLoS One. doi: 10.1371/journal.pone.0216108.


Migraine is comorbid with depression and anxiety. Both of the latter also occur at higher rates with chronic than episodic migraine. Other pain physical symptoms (PPS), such as chronic low back pain, are associated with progression from episodic to chronic migraine. The current study documents that the presence of the PPS parallels the activity of the migraine at a 2-year follow up. That is, active migraine and PPS occurred together, while inactive migraine and PPS did not. The severity of the migraine by intensity measures also correlated with the intensity of the PPS. The investigators felt that “active headache might be an important index to predict other PPS among MDD patients with migraine”, and that active migraine was associated with reduced rates of depression remission. Clinically, this suggests that optimal migraine management might decrease the likelihood of continuing depression and chronic pain, as well as reducing the likelihood of migraine chronification.

-Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH