Depression’s Impact on Development of Chronic Migraine

According to a pain and neurology researcher presenting at the recent European Headache and Migraine Trust International Congress in London, depression among people with episodic migraine is an independent risk factor for development of chronic migraine.

Dr. Sait Ashina of the Albert Einstein College of Medicine reviewed data from the ground-breaking American Migraine Prevalence and Prevention (AMPP) Study to see whether there were any trends among people living with both depression and episodic migraine and the likelihood of transformation to chronic migraine. The AMPP Study is the largest study of migraine patients that has ever been undertaken.

According to data from the AMPP study, depressed migraineurs were 1.65 times more likely to progress to chronic migraine within the next year than migraine patients who were not depressed. The more severe the patient’s depression, the more likely the patient was to develop chronic migraine.

Even after adjusting for factors known to contribute to the development of chronic migraine, such as cutaneous allodynia, anxiety disorders, headache pain intensity, headache frequency, migraine symptom severity, medication overuse, body mass index, income and health insurance status, Dr. Ashina said the presence of depression was still a statistically significant factor in transformation to chronic migraine.

Dr. Ashina emphasized that depression worsens migraine, but migraine also worsens depression. The two have a very interconnected relationship. Management of one can often be helpful to management of the other. In fact, ignoring management of one of these conditions is detrimental to both.

In order to try to prevent episodic migraine from becoming chronic it is important that headache specialists screen their migraine patients for depression and get those patients who need it well rounded treatment. Medication, psychotherapy and exercise can all be helpful tools in the management of depression.

About 1/4 of patients with chronic migraine return to episodic status after developing chronic migraine each year. While this is good news for that 1/4 of patients, for the other 3/4, it is especially important for care providers to try everything possible to prevent the transformation in the first place.

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