Depression and Anxiety Linked to Migraine Disability

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Depression and anxiety are often present in patients with migraine, especially those with chronic migraine. Some studies even suggest a common genetic link between depression and migraine. Many of us who live with migraine have suggested that the challenges of living with the condition contribute to the development of depression and anxiety. Now there is evidence that even mild depressive or anxiety symptoms can have a significant impact on Migraine.

Study objective

This studyexamined the relationship between chronic migraine and migraine-related disability and the psychological factors of depression, anxiety, maladaptive thought patterns, and migraine-related beliefs.

Study methods

Ninety participants with a confirmed migraine diagnosis from a headache specialty clinic were surveyed using the following self reporting questionnaires:

  • Migraine Disability Assessment (MIDAS) assessed both chronic migraine and migraine-related disability.
  • Patient Health Questionnaire (PHQ-9) assessed the severity of depressive symptoms.
  • Generalized Anxiety Disorder (GAD-7) questionnaire assess the severity of anxiety symptoms.
  • Pain Catastrophizing Scale (PCS) assessed the level of catastrophic thinking.
  • Headache Specific Locus of Control (HSLC) assessed the extent to which participants believed their migraines are influence by their own actions, the actions of their doctor, or fate/chance.

Study results

Migraine

  • 36 percent had chronic migraine.
  • 51.5 percent had severe migraine-related disability.

Depressive symptoms

  • Average PHQ-9 score was “mild” depression severity.
  • 56.6 percent had no or minimal depressive symptoms.
  • 21.3 percent had mild symptoms.
  • 22.2 percent had moderate to severe symptoms.
  • Increased depressive symptoms were associated with both chronic migraine and migraine-related disability.

Anxiety symptoms

  • Average score was none or minimal symptoms.
  • Two-thirds had none or minimal symptoms.
  • 21.7 percent had mild symptoms.
  • 10.8 percent had moderate to severe symptoms.
  • Not associated with chronic migraine
  • Associated with migraine-related disability

Pain catastrophizing

  • Not associated with chronic migraine
  • Associated with migraine-related disability

Headache-specific locus of control

  • Patients reporting chance locus of control (belief that nothing can control migraine) were more likely to report chronic migraine.
  • No association with migraine-related disability

Study conclusions

Depression and anxiety

  • Higher rates of depressive and anxiety symptoms were associated with increased migraine-related disability.
  • Even small increases in these symptoms were associated with increased frequency and disability.
  • Migraine patients with depression are at higher risk of developing chronic migraine.
  • Treating these symptoms in addition to migraine treatment often results in significant improvement of migraine symptoms.

Pain catastrophizing

  • Pain catastrophizing was associated with migraine-related disability
  • Study was not designed to determine if catastrophizing caused disability. It is just as likely that severe migraine-related disability contributes to catastrophizing or some other factors are involved.
  • Treatment for symptoms of depression and anxiety also address these thought patterns.
  • Future interventions could emphasize treatment of depression and anxiety in general rather than focusing on only catastrophizing.

Headache-related locus of control

  • Chronic migraine was associated with patient reports of belief that nothing can control migraine attacks.
  • Authors state that this association may be due to the relative difficulty of trigger identification common in chronic Migraine.
  • Previous studies suggest that such beliefs are associated with maladaptive coping strategies.
  • Authors note that is quite possible this belief plays minimal or no role in the migraine symptoms and recommend further studies to examine any associations between the two.

Other study observations

  • Because the participants were seen at a migraine clinic, the results of this study may not represent the experience of migraine patients in general.
  • Gaining an understanding of the psychological factors associated with migraine-related disability could improve treatment of those most disabled by migraine.
  • The participants were mostly middle-aged, well-educated, insured, white women. Their reported experiences may not apply to other patient groups.
  • The anxiety screening questionnaire only assessed symptoms of Generalized Anxiety Disorder. Patients with other anxiety disorders may not have the same experiences reported by the study participants.

Recommendations for future studies

  • Use of migraine diaries to improve accuracy of symptom reporting
  • Comprehensive, long-term studies are needed to determine the relationship between psychological factors, chronic Migraine, and Migraine-related disability.
  • Randomized clinical trials are needed to assess the most effective interventions to treat psychological factors that affect Migraine.

Take-away for patients:

  • Even minor symptoms of depression or anxiety can have a significant effect on migraine.
  • Report any symptoms of depression or anxiety to the doctor who treats you for migraine.
  • If you struggle with depression or anxiety, ask your doctor for a referral to a mental health provider who is knowledgeable about Migraine.

See more helpful articles:

Catastrophizing in Chronic Migraine

Basics of Cognitive Behavioral Therapy for Migraine

Migraine Patient’s Guide to Understanding Depression

Migraine and Mental Health: Those Prodrome Mood Swings