Anxiety and depression associated with migraine: Influence on migraine subjects' disability and quality of life, and acute management
Department of Evaluation and Treatment of Pain, University Teaching Hospital, Hospital Pasteur, 06602 Nice, France. Pain
(Impact Factor: 5.21).
12/2005; 118(3):319-26. DOI: 10.1016/j.pain.2005.09.010
Anxiety and depression are reported to be frequently associated with migraine but how they impact on migraine-related disability, migraine subjects' quality of life, and medical and therapeutic management of migraine attacks has not been investigated. FRAMIG 3 is a nation-wide population-based postal survey carried out in France according to the 2004 international classification of headache disorders. Subjects who had had migraine attacks during the last 3 months (subjects with 'active migraine', N = 1957) were analysed for migraine-related disability (MIDAS score), quality of life (SF-12 questionnaire), and anxiety and depression (Hospital Anxiety and Depression Scale [HADS]) in comparison with non-migraine subjects (N = 8287). Survey results indicate that 50.6% of subjects with active migraine were anxious and/or depressive (28.0% had anxiety alone, 3.5% depression alone, and 19.1% both anxiety and depression; P < or = 0.01 versus non-migraine subjects for anxiety alone and combined anxiety and depression, NS for depression alone). Although, migraine-associated anxiety and depression do not appear to influence the drugs taken by migraine subjects for the acute treatment of migraine attacks, perceived treatment efficacy and satisfaction with treatment are lower in subjects with anxiety alone or combined with depression than in subjects with neither anxiety nor depression. Anxiety and depression should be systemically looked for and cared for in subjects consulting for migraine.
Available from: Joseph R Hibbeln
- "Patients with chronic headaches often have high levels of psychological distress , including depressive symptoms [23; 37], anxiety [25; 41; 54], and somatization [21; 48]. Psychological distress can exacerbate the adverse impact of headache on health-related quality of life (HRQOL) , and may reduce efficacy of headache interventions . Interventions targeting both physical and psychological dimensions of pain may produce maximal improvements in HRQOL. "
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ABSTRACT: Omega-3 and omega-6 fatty acids are precursors of bioactive lipid mediators posited to modulate both physical pain and psychological distress. In a randomized trial of 67 subjects with severe headaches, we recently demonstrated that targeted dietary manipulation-increasing omega-3 fatty acids with concurrent reduction in omega-6 linoleic acid (the H3-L6 intervention)-produced major reductions in headache compared with an omega-6 lowering (L6) intervention. Because chronic pain is often accompanied by psychological distress and impaired health-related quality of life (HRQOL), we used data from this trial to examine whether the H3-L6 intervention favorably impacted these domains. Additionally, we examined the effect of the interventions on the number of cases with substantial physical or mental impairments as defined by cutoff values in the Brief Symptom Inventory (BSI-18), Medical Outcomes Study Short Forms 12 (SF-12), Headache Impact Test (HIT-6), and the number of headache days per month. In the intention-to-treat analysis, participants in the H3-L6 group experienced statistically significant reductions in psychological distress (BSI-18 mean difference: -6.56; 95% confidence interval [CI]: -11.43 to -1.69) and improvements in SF-12 mental (mean difference: 6.01; 95% CI: 0.57 to 11.45) and physical (mean difference: 6.65; 95% CI: 2.14 to 11.16) health summary scores. At 12 weeks, the proportion of subjects experiencing substantial impairment according to cutoff values in the BSI-18, SF-12 physical, HIT-6, and headache days per month was significantly lower in the H3-L6 group. Dietary manipulation of n-3 and n-6 fatty acids, previously shown to produce major improvements in headache, was found to also reduce psychological distress and improve HRQOL and function.
Available from: PINAR YALINAY DIKMEN
- "Disability was the most important determinant of the severity of depressive symptoms in primary headaches including migraine . Anxiety and depression have been found to be related to MIDAS scores in outpatient settings , headache referral clinics  and in the general population . Notably, depressive symptoms were significantly correlated with numbers of attacks per month in our study population, but not MIDAS total scores or migraine related disability, although numbers of migraine attacks per month were strongly associated with MIDAS scores. "
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Depression and anxiety are two phenomena that affect quality of life as well as sexual function. Depression and anxiety levels are reported to be high in migraine sufferers. We aimed to understand whether sexual function in women with migraine was associated to migraine-related disability and frequency of migraine attacks, and whether this relationship was modulated by depressive and anxiety symptoms.
As migraine is more commonly seen in females, a total of 50 women with migraine were included. The diagnosis of migraine with or without aura was confirmed by two specialists in Neurology, according to the second edition of International Headache Society (IHS) International Classification of Headache Disorders (ICHD-II) in 2004. Migraine disability assessment scale score, female sexual function index scores, Beck depression inventory score and Beck anxiety inventory scores.
Mean MIDAS score was 19.3 ± 12.8, and mean number of migraine attacks per month were 4.3 ± 2.7. Mean Female Sexual Function Index score was 20.9 ± 5.9 and 90% of patients had sexual dysfunction. Sexual dysfunction was not related to MIDAS score or frequency and severity of attacks. No relationship between sexual function and anxiety was found, whereas severity of depressive symptoms was closely related to sexual function. Depressive symptoms affected all dimensions of sexual function, except for pain.
Sexual dysfunction seemed to be very common in our patients with migraine, while not related to migraine related disability, frequency of attacks and migraine severity or anxiety. The most important factor that predicted sexual function was depression, which was also independent of disease severity and migraine related disability. While future larger scale studies are needed to clarify the exact relationship, depressive and sexual problems should be properly addressed in all patients with migraine, regardless of disease severity or disability.
Available from: Dildar Konukoglu
- "It was concluded that the psychological comorbidities are a common problem in migraine patients and have an additive effect on the risk of migraine progression
[26,30]. The prevalence of major depression has been reported in a number of studies to be 1.7 fold or higher among individuals with migraine compared to non-migraineurs
. In a recent study Ligthart and associates analyzed a cohort with different types of chronic pain and concluded that anxiety and depression can explain a considerable part of the comorbidity of migraine and other types of pain
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ABSTRACT: Comorbidity of migraine with anxiety and depression may play a role in the link between migraine and obesity. We examined the moderating and mediating roles of ghrelin in the relationship between depression (and anxiety) and body weight in newly diagnosed migraineurs.
Participants were 63 newly diagnosed migraine patients (using the ICHD-II criteria) and 42 healthy volunteers. Body mass index was calculated by measuring height and weight. Ghrelin was assessed at fasting. Depression was assessed with the Hamilton Depression scale, and anxiety with the Hamilton Anxiety scale.
The data did not support the mediating role of ghrelin in the relationship between depression (or anxiety) and BMI for either the migraine or the control group. The interaction between ghrelin and depression as well as anxiety was significant for the migraine group, but not for the control group. Depressed (or anxious) migraineurs had a positive association between ghrelin and BMI, whereas for the non-depressed (or non-anxious) migraineurs this association was negative.
Depression and anxiety moderated the effect of ghrelin on BMI for migraineurs. Management of anxiety and depression might be regarded as part of migraine treatment.
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