Risk factors associated with migraine or chronic daily headache in out-patients with major depressive disorder

Illness perception and quality of life in patients with migraine and tension-type headache

INTRODUCTION

Migraine and tension-type headache (TTH) are important health problems because cause loss of workforce, affect quality of life and are frequently associated with anxiety and depression. Illness perception is defined as a cognitive aspect of illness. The aim of this study is to determinethe relationship of migraine and TTH with quality of life, illness perception, anxiety and depression.

MATERIALS AND METHODS

Demographic information and headache characteristics of 160 patients (80 migraine, 80 TTH) who has applied to our hospital's neurology outpatient clinics were recorded. Hospital anxiety depression scale, illness perception questionnaire and quality of life short form-36 (SF-36) were applied to these patients.

RESULTS

Headache severity and duration were higher in migraine patients. Migraine sufferers believed that their illness would last longer and the results would be worse. Negative emotional representations were more common in TTH patients. Understanding of the disease was higher in younger and those with higher levels of education. Social functionality and bodily pain scores were worse than those of TTH patients. Headache severity and duration were higher in women. Anxiety and depression were associated with headache frequency, duration, and severity. It was determined that the severity, duration and frequency of headache also affected the quality of life.

CONCLUSION

Informing patients in detail about their diseases and increasing their education level can contribute to the improvement of headache representations. In addition, screening and treatment of anxiety and depression may be other interventions that can improve patients' adherence to treatment and quality of life.

Preliminary Study of a Scale Measuring Depression and Somatic Symptoms

This description concerns the development of a scale measuring depression and somatic symptoms and the selection of its items for a Taiwanese sample. 102 Taiwanese outpatients (28 men, 74 women) with major depressive disorder completed a 44-item preliminary scale. All had experienced a major depressive episode but had not been treated by antidepressants within the prior two weeks. The Hamilton Depression Rating Scale was administered to evaluate the validity of the Depression and Somatic Symptoms Scale (DSSS). Items, 12 for the Depression Subscale and 10 for the Somatic Subscale, were selected for the Depression and Somatic Symptoms Scale according to their frequency and their association with rated severity of depression and clinical practices. The mean Hamilton Depression score was 23.9 ( SD = 5.2) versus 38.4 ( SD = 11.3) for the total DSSS; means for the Depression subscale were 23.5 ± 6.0 and the Somatic subscale 14.9 ± 6.8. Cronbach alpha was .88 for the total DSSS, .78 for the Depression subscale, and .86 for the Somatic subscale. The Pearson correlation coefficient for the two scales was .59 ( p < .01). The new scale had adequate internal consistency reliability and convergent validity. Much study is required to assess its structure, item characteristics, and in judging its applicability and limitations, and sensitivity to cultural differences in clinical settings.

The Prevalence of Dry Eye and Sjögren Syndrome in Patients with Migraine

PURPOSE

To evaluate the presence of dry eye and primary Sjögren syndrome (SS) in patients with migraine.

METHODS

In total, 46 eyes of 46 patients with migraine (group 1) and 50 eyes of 50 healthy subjects (group 2) were included in this study. Detailed ophthalmologic, neurologic and rheumatologic examination were performed on all participants. Ocular surface disease index questionnaire, tear function tests, visual analog scale for pain, serologic analysis were also performed.

RESULTS

Dry eye symptoms and findings were significantly higher and more severe in group 1 when compared with group 2. Primary SS was not found in any of the participants. The migraine lifetime duration was negatively correlated with the tear function tests while it was positively correlated with the ocular surface disease index scores.

CONCLUSIONS

Dry eye symptoms and findings are higher in migraine patients when compared with the healthy subjects without the presence of Sjögren syndrome.

The contribution of stress to the comorbidity of migraine and major depression: results from a prospective cohort study

OBJECTIVES

To assess how much the association between migraine and depression may be explained by various measures of stress.

DESIGN

National Population Health Survey is a prospective cohort study representative of the Canadian population. Eight years of follow-up time were used in the present analyses.

SETTING

Canadian adult population ages 18-64.

PARTICIPANTS

9288 participants.

OUTCOME

Incident migraine and major depression.

RESULTS

Adjusting for sex and age, depression was predictive of incident migraine (HR: 1.62; 95% CI 1.03 to 2.53) and migraine was predictive of incident depression (HR: 1.55; 95% CI 1.15 to 2.08). However, adjusting for each assessed stressor (childhood trauma, recent marital problems, recent unemployment, recent household financial problems, work stress, chronic stress and change in social support) decreased this association, with chronic stress being a particularly strong predictor of outcomes. When adjusting for all stressors simultaneously, both associations were largely attenuated (depression-migraine HR: 1.30; 95% CI 0.80 to 2.10; migraine-depression HR: 1.19; 95% CI 0.86 to 1.66).

CONCLUSIONS

Much of the apparent association between migraine and depression may be explained by stress.

Chronic migraine and chronic daily headache in the Asia-Pacific region: a systematic review

BACKGROUND

Data on the prevalence and characteristics of chronic migraine (CM) and chronic daily headache (CDH) in the Asia-Pacific region are limited.

METHODS

We performed a systematic review on this topic, searching for studies published from 1996 to 2012 that reported the prevalence (population-based studies) or frequency (clinic studies) of CM or CDH. We calculated 95% confidence intervals for the prevalence in population studies. Results were qualitatively described.

RESULTS

Seven population studies and 19 hospital clinic studies from Asia were included. The CDH prevalence in population studies was 1.0-3.9% (median 2.9%). Only two studies from Taiwan reported the population prevalence of CM (1.0% and 1.7%). In addition, we derived a prevalence of 0.6% from a Malaysian study. Eleven clinic studies reported a CM frequency of 4.7-82% (median 52%) as a subset of CDH; classification of medication overuse varied. CM was associated with substantial disability.

CONCLUSIONS

The prevalence of CM and CDH in Asia appears lower than the global average, but applying the above prevalence estimates to the Asia-Pacific population would suggest that CM alone affects between 23 and 65 million individuals in the region.

Prevalence of and influencing factors for chronic headaches among pregnant women

OBJECTIVE

To determine the prevalence of headaches and their influencing factors among pregnant women.

METHODS

A cross-sectional study was conducted from January 3 to April 29, 2005, with 1357 women receiving routine pregnancy check-ups at the obstetric clinics of the community health institutions of Kayseri, Turkey. A structured questionnaire and the Zung Depression Scale were used to collect data.

RESULTS

Overall, 24.6% (95% confidence interval, 22.3%-26.9%) of the participants had headaches before pregnancy, whereas only 17.9% (95% confidence interval, 15.9%-20.1%) had headaches during pregnancy. Although the headache prevalence was lower during than before pregnancy, it was high among the participants aged 35 years or older, those who received help in their housework, and those who were multiparous. Moreover, the Zung depression score was significantly high among those experiencing headaches.

CONCLUSION

The significant decrease in headache prevalence observed during pregnancy may be the result of a pregnancy-specific hormonal status. However, the most significant factors influencing the frequency of headaches in the participants were related to their socioeconomic status and the severity of depression.

High prevalence of comorbidity of migraine in outpatients with panic disorder and effectiveness of psychopharmacotherapy for both disorders: a retrospective open label study

We investigated the comorbidity rate of migraine in outpatients with panic disorder, and the efficacy of pharmacotherapy for both disorders. Fifty-four patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for panic disorder were recruited in the study. Forty-three patients were female, and their age ranged from 20 to 71 (38.8±11.2; mean±S.D.) years. Forty-one patients had agoraphobia. In these patients, we diagnosed migraine and other types of headache, using the International Classification of Headache Disorders, Second Edition (ICHD-II). Forty-three (79.6%) patients were diagnosed as having some type of headache; 33 (61.1%) migraine, 32 tension-type headache, and one cluster headache. In patients with migraine, treatment for panic disorder also improved their migraine in 19 (57.6%) patients. The mean onset age of panic disorder in patients with migraine was statistically significantly younger than that in non-migraine patients. The Clinical Global Impression Improvement (CGI-I) score of panic disorder was statistically significantly correlated with the CGI-I score of migraine. A high comorbidity rate (61.1%) of migraine was observed in outpatients with panic disorder, and our result suggests that treatment with antidepressants for panic disorder may also be effective for prophylaxis of migraine.

Migraine and psychiatric comorbidity: a review of clinical findings

Migraine is an extremely common disorder. The underlying mechanisms of this chronic illness interspersed with acute symptoms appear to be increasingly complex. An important aspect of migraine heterogeneity is comorbidity with other neurological diseases, cardiovascular disorders, and psychiatric illnesses. Depressive disorders are among the leading causes of disability worldwide according to WHO estimation. In this review, we have mainly considered the findings from general population studies and studies on clinical samples, in adults and children, focusing on the association between migraine and psychiatric disorders (axis I of the DSM), carried over after the first classification of IHS (1988). Though not easily comparable due to differences in methodology to reach diagnosis, general population studies generally indicate an increased risk of affective and anxiety disorders in patients with migraine, compared to non-migrainous subjects. There would also be a trend towards an association of migraine with bipolar disorder, but not with substance abuse/dependence. With respect to migraine subtypes, comorbidity mainly involves migraine with aura. Patients suffering from migraine, however, show a decreased risk of developing affective and anxiety disorders compared to patients with daily chronic headache. It would also appear that psychiatric disorders prevail in patients with chronic headache and substance use than in patients with simple migraine. The mechanisms underlying migraine psychiatric comorbidity are presently poorly understood, but this topic remains a priority for future research. Psychiatric comorbidity indeed affects migraine evolution, may lead to chronic substance use, and may change treatment strategies, eventually modifying the outcome of this important disorder.

Nociceptive and anxiety-like behavior in reproductively competent and reproductively senescent middle-aged rats

BACKGROUND

Changes in levels of estradiol and progesterone that occur with the transition to reproductive senescence may influence nociception or affect.

OBJECTIVE

To ascertain whether nociceptive and affective processes change with reproductive senescence, this study examined pain and anxiety-like behaviors in middle-aged female rats that were reproductively competent, transitioning to reproductive senescence, or reproductively senescent.

METHODS

Middle-aged (12-14 months old) female rats (N = 46) were tested in the following tasks to assess pain and anxiety-like behavior: tail flick, elevated plus maze, elevated zero maze, mirror maze, Vogel punished drinking, and defensive burying. For the tail-flick task, the latency for rats to move their tail from a heat source, as an indication of pain sensitivity, was determined. In the elevated plus and elevated zero mazes, the time spent on the open arms or quadrants, respectively, were determined as measures of reduced anxiety behavior. In the mirror maze, the time spent in the mirrored portion of the chamber was used as an indicator of anxiety-like responding. In the Vogel task, the number of punished licks made was determined as a measure of reduced anxiety-like behavior. In the defensive burying task, the duration spent by rats burying an electrified prod postfootshock was utilized as an index of anxietylike responding. All rats were experimentally naive, retired breeders from our colony and had not had a litter or been lactating for 1 to 4 weeks before behavioral testing.

RESULTS

Although tail-flick latencies were not significantly different among rats that were reproductively competent or senescent, reproductively competent rats had less anxiety-like behavior in the elevated plus maze (more time spent on the open arms: F(2,43) = 5.93; P < 0.01), elevated zero maze (more time spent on the open quadrants: F(2,43) = 4.62; P = 0.01), and Vogel punished drinking task (more punished licks made: F(2,43) = 3.76; P = 0.03). There were no statistically significant differences in the mirror maze and defensive burying task.

CONCLUSION

In this study of adult female rats, nociceptive behavior did not vary significantly with reproductive senescence, but anxiety-like behavior of rats did.

Psychiatric comorbidity and suicide risk in patients with chronic migraine

The aim of this study was to explore the impact of mental illness among patients with migraine. We performed MedLine and PsycINFO searches from 1980 to 2008. Research has systematically documented a strong bidirectional association between migraine and psychiatric disorders. The relationship between migraine and psychopathology has often been clinically discussed rather than systematically studied. Future research should include sound methodologically-based studies focusing on the interplay of factors behind the relationship between migraine, suicide risk, and mental illness.

Psychiatric disorders and headache familial recurrence: a study on 200 children and their parents

The main aim of the study was to examine the relationship between headache and familial recurrence of psychiatric disorders in parents and their children. Headache history and symptomatology have been collected in a clinical sample of 200 patients and their families, using a semi-structured interview (ICHD-II criteria). Psychiatric comorbidity was assessed by DSM-IV criteria. Chi squares and a loglinear analysis were computed in order to evaluate the main effects and interactions between the following factors: frequency and headache subtypes (migraine/not-migraine) in children, headache (migraine/not-migraine-absent/present) in parents, headache (absent/present) in grandparents, and psychiatric comorbidity (absent/present) have been analyzed: 94 mothers (47%) and 51 fathers (25.5%) had at least one psychiatric disorder, mainly mood and anxiety disorders. Considering the significant prevalence of Psi-co in children (P < 0.0001), we compared it with the presence of familiarity to headache: a significant interaction has been found (P < 0.05) showing that migraineurs with high familial recurrence of headache had a higher percentage (74.65%) of psychiatric disorders, than no-migraineurs (52.17%). Absence of headache familial loading seems to be related to psi-co only in no-migraine headache (87.5 vs. 45.5%). The occurrence of psychiatric disorders is high in children with headache, but a very different pattern seems to characterize migraine (familial co-transmission of migraine and Psi-Co?) if compared with non-migraine headache.

Migraine predicts self-reported muscle tension in patients with major depressive disorder

BACKGROUND/OBJECTIVE

The aim of this study was to identify factors related to muscle tension in patients with major depressive disorder (MDD) with comorbid anxiety and migraine.

METHOD

Consecutive psychiatric outpatients with MDD were enrolled. Self-reported muscle tension (SMT) during the previous week was evaluated with a 0-10 scale.

RESULTS

Of 135 participants with MDD, 63 (46.7%) had migraine. Multiple-regression analyses showed that migraine and headache intensity were two major independent factors related to SMT.

CONCLUSION

Further studies on musculoskeletal symptoms in MDD should not neglect the impact of migraine.

Barriers to satisfactory migraine outcomes. What have we learned, where do we stand?

Barriers to optimal migraine care have traditionally been divided into a number of categories: under-recognition and underconsultation by migraine sufferers; underdiagnosis and undertreatment by health care professionals; lack of follow-up and treatment optimization. These "traditional" barriers have been recognized and addressed for at least 15 years. Epidemiologic studies suggest that consultation, diagnosis, and treatment rates for migraine have improved although many migraine sufferers still do not get optimal treatment. Herein, we revisit the problem, review areas of progress, and expand the discussion of barriers to migraine care. We hypothesize that the subjective nature of pain and difficulty in communicating it contributes to clinical and societal barriers to care. We then revisit some of the traditional barriers to care, contrasting rates of recognition, diagnosis, and treatment over the past 15 years. We follow by addressing new barriers to migraine care that have emerged as a function of the knowledge gained in this process.

The impact of anxiety and migraine on quality of sleep in patients with major depressive disorder

OBJECTIVE

The aim of this study was to investigate the impact of anxiety disorders and migraine on sleep quality and to find the independent factors that predict sleep quality among patients with major depressive disorder (MDD).

METHOD

Psychiatric outpatients diagnosed with MDD were enrolled in the study. Major depressive disorder and 7 anxiety disorders were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Migraine was diagnosed based on the International Classification of Headache Disorders, Second Edition. Headache intensity and frequency were reported by the subjects. The Pittsburgh Sleep Quality Index and Hamilton Depression Rating Scale were used to evaluate quality of sleep and depression severity, respectively. Multiple linear regressions were used to identify independent factors related to sleep quality.

RESULTS

One hundred thirty-five subjects (34 men and 101 women) with MDD were enrolled in the study. Subjects with panic disorder and agoraphobia were found to have poorer Pittsburgh Sleep Quality Index scores. Subjects with panic disorder, agoraphobia, and migraine had higher scores for items relating to sleep quality in the Hamilton Depression Rating Scale. Headache intensity and frequency correlated with sleep disturbance. Panic disorder was independently predictive of poor sleep quality. Both migraine and panic disorder independently predicted a greater severity of depression.

CONCLUSION

Our study demonstrates the negative impact of panic disorder and migraine on MDD and some of the interrelations between depression, anxiety, and sleep quality. Future studies should further explore these interactions and consider possible therapeutic interventions.

The impacts of migraine, anxiety disorders, and chronic depression on quality of life in psychiatric outpatients with major depressive disorder

OBJECTIVE

Our purpose was to determine if migraine, anxiety comorbidities, and chronic depression were independently related to health-related quality of life (HRQoL) in outpatients with major depressive disorder (MDD).

METHOD

Consecutive psychiatric outpatients with MDD in a medical center were enrolled. MDD, chronic depression, and seven anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. Migraine was diagnosed based on the International Classification of Headache Disorders, 2nd edition. The acute version of the Short-Form 36 and the Hamilton Depression Rating Scale (HAMD) were used to evaluate the HRQoL and the severity of depression, respectively. Multiple linear regressions were used to determine the independent factors related to HRQoL.

RESULTS

There were 135 participants (34 men, 101 women) with MDD. Subjects with migraine, anxiety comorbidities, or chronic depression had higher HAMD scores and poor HRQoL. Migraine, specific phobia, and panic disorder were important and independent comorbidities predicting HRQoL. The impact of migraine on HRQoL, especially on bodily pain, was not inferior to those of some anxiety comorbidities or chronic depression.

CONCLUSION

Future studies related to HRQoL of MDD should consider migraine and anxiety comorbidities simultaneously.

Prevalence and Associated Factors for Episodic and Chronic Daily Headache in the Colombian Population

There are multiple risk factors for chronic daily headache (CDH), but they are usually assessed in an isolated form without an adequate control for confounders. CDH is considered a variant of episodic headache, but studies have not gathered enough evidence to evaluate simultaneously CDH and episodic in the same population. We set out to establish simultaneously the factors associated with chronic daily or episodic headache in a population setting, using a cross-sectional survey in a random sample of 1505 adult urban inhabitants (Bucaramanga, Colombia). The survey asked questions about headache, family and personal history of disease, and consumption or abuse of caffeine, alcohol, hypnotics and analgesics. The association among independent variables and CDH or episodic headache was made with multinomial logistic regression. Female gender, arterial hypertension or cranial trauma history, and a high score in the depression scale are associated with episodic headache and CDH. Parents with CDH, the complaint of multiple arousals during sleep and use of hypnotics are associated with CDH, but not with episodic headache. Age < 36 years, alcoholism and snoring are factors associated only with episodic headache. Chronic daily headache and episodic headache have several common risk factors, but there are other factors not shared by both conditions.

Impact of gender on clinical presentation of chronic rhinosinusitis with and without polyposis

STUDY OBJECTIVE

To determine the impact of a patient's gender on the clinical presentation of chronic rhinosinusitis with and without nasal polyposis.

STUDY DESIGN AND METHODS

Prospective study of 514 adult patients who presented with chronic rhinosinusitis with and without nasal polyposis. The patients were divided into two groups based on gender: female (n = 273) and male (n = 241). The following data were collected: presenting symptoms, co-morbidities, nasal endoscopy and sinus computed tomography findings, diagnosis, and outcome of surgery. Statistical analysis was performed using the chi-square test, with statistical significance set at p < 0.05.

RESULTS

Facial pain and headache were more prevalent among women, while nasal obstruction was more prevalent among men (p < 0.05). There was no statistically significant difference in the prevalence of environmental allergy, asthma, psychiatric illness or anatomical variants obstructing the osteomeatal unit, comparing the genders. Chronic rhinosinusitis without polyposis was the more common diagnosis among women, while chronic rhinosinusitis with polyposis was the more common diagnosis among men (p < 0.05). Following surgery, a higher percentage of male patients reported improvement in nasal obstruction (p < 0.05), but there was no statistically significant difference in the improvement of the other presenting symptoms, comparing the genders.

CONCLUSION

Women who suffer from chronic rhinosinusitis are more likely to complain of facial pain or headache on presentation and to be diagnosed with chronic rhinosinusitis without polyposis. On the other hand, men are more likely to complain of nasal obstruction, to be diagnosed with chronic rhinosinusitis with polyposis, and to report improvement in nasal obstruction following surgery.

Psychiatric comorbidity of migraine

Migraine affects nearly 12% of the adult population in the United States and causes significant lost productivity and decrements in health-related quality of life. The burden of migraine and the challenge in managing it are increased by the comorbid psychiatric conditions that occur in association with it. Studies in both clinical and community-based settings have demonstrated an association between migraine and a number of specific psychiatric disorders. This review will focus on the relationships between migraine and depression, generalized anxiety disorder, panic disorder, and bipolar disorder. In large scale population-based studies, persons with migraine are from 2.2 to 4.0 times more likely to have depression. In longitudinal studies, the evidence supports a bidirectional relationship between migraine and depression, with each disorder increasing the risk of the other disorder. Migraine is also comorbid with generalized anxiety disorder (Odds Ratio [OR] 3.5 to 5.3), panic disorder (OR 3.7), and bipolar disorder (OR 2.9 to 7.3). A diagnosis of migraine should lead to a heightened level of diagnostic suspicion for these comorbid psychiatric disorders. Similarly, a diagnosis of one of these psychiatric disorders should increase vigilance for migraine. Treatment plans for migraine should be mindful of the comorbid conditions.

Depression and somatic symptoms scale: a new scale with both depression and somatic symptoms emphasized

The authors' preliminary study selected 22 items for Depression and Somatic Symptoms Scale (DSSS), including depression subscale (DS) and somatic subscale (SS). The aim of the study was to test reliability and validity of the DSSS. The study enrolled 135 consecutive outpatients (34 male and 101 female) experiencing a major depressive episode (the MDE group), 95 of whom (25 male and 70 female) accepted 1 month of treatment (the treatment group). Diagnosis was confirmed by using the Structured Clinical Interview for 4(th) edition with text revision Diagnostic and Statistical Manual Axis I Disorders. The DSSS and Hamilton Depression Rating Scale (HAMD) were given and evaluated. Cronbach's alpha was used to assess internal consistency. The correlation between the improvement percentage (IP) for the HAMD and the IP for the DSSS was calculated for the treatment group. Factor analysis was performed by using the principal-axis factoring method with promax rotation. Cronbach's alpha values of the DSSS and its subscales ranged from 0.73 to 0.94. Pearson correlation coefficients for the relationship between the DSSS and HAMD ranged from 0.63 to 0.86. In the treatment group, DSSS and HAMD scores were significantly decreased after treatment and the IP for the HAMD and the DSSS were similar and correlated (correlation coefficient = 0.78). The results of the factor analysis demonstrated that most of the items in DS and SS appropriately loaded in Depression and Somatic factors, respectively. The discriminative ability of the DSSS for anxiety comorbidities was not inferior to that of the HAMD. Therefore, the DSSS is reliable and sensitive to the treatment and has acceptable convergent, factorial, and distinct-groups validities. Because it assesses both depression and somatic symptoms, DSSS may overcome the deficiency of other depression scales with few somatic items.

The Impact of Migraine on Patients With Major Depressive Disorder

BACKGROUND

The impact of migraine and other headache types among psychiatric outpatients with major depressive disorder (MDD) has not been fully described.

OBJECTIVE

To investigate the impact of migraine on the severity, physical, and anxiety symptoms in patients with MDD and to examine the interaction between headache and depression.

METHODS

This clinic-based study enrolled consecutive psychiatric outpatients meeting DSM-IV criteria for MDD. Headache types were diagnosed based on the International Classification of Headache Disorders, 2nd edition (2004). Three psychometric instruments were used to evaluate anxiety, depression, and physical components: the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale. In addition, the interactions between headache and their depressive episode were also evaluated.

RESULTS

Compared with patients without migraine, MDD patients with comorbid migraine (n = 73, 48.3%) had higher physical and anxiety scores on the three psychometric instruments. Migraine accounted for 5% to 11% of the variance of the total scores on the three psychometric scales. Approximately half (48.5%) of patients reported headache worsening during or after a depressive episode.

CONCLUSIONS

Our study found that comorbidity of migraine in patients with MDD was associated with more anxiety and physical symptoms. Headache should not be considered as only a somatic symptom of depression, but should be treated as an important comorbid disorder because it might exacerbate or interact with depression during a depressive episode.