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

Abstract

ObjectivesTo assess how much the association between migraine and depression may be explained by various measures of stress.DesignNational 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.SettingCanadian adult population ages 18–64.Participants9288 participants.OutcomeIncident migraine and major depression.ResultsAdjusting 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).ConclusionsMuch of the apparent association between migraine and depression may be explained by stress.

Early Life Stress in Adolescent Migraine and the Mediational Influence of Symptoms of Depression and Anxiety in a Canadian Cohort

“…At present, the relationship between headache and symptoms of depression and anxiety is not well understood, 42 despite the sizeable evidence to support their comorbidity. 21,24 The mediational processes modeled here spread over a long follow-up period of 14 years; as such, the exposures may be considered distal to the studied outcomes, contributing to the lack of direct relationships between early life stress and headache measures (path c′: X→Y controlling for M). 21,24 The mediational processes modeled here spread over a long follow-up period of 14 years; as such, the exposures may be considered distal to the studied outcomes, contributing to the lack of direct relationships between early life stress and headache measures (path c′: X→Y controlling for M).…”

“…12 Adolescents experiencing recurrent headaches report more psychological distress 13 and pediatric migraineurs seeking subspecialty care report higher symptoms of depression and anxiety as compared to peers. 21 Exposure to early life stressors is associated with onset of symptoms of depression and anxiety in childhood and adolescence. 16,17 In addition, prospective epidemiologic work has uncovered associations between symptoms of depression and anxiety in late childhood/adolescence and new onset headache 18 and migraine, 19,20 and a bidirectional migrainedepression relationship.…”

Mechanisms of Stress in Humans

“…Numerous studies have linked chronic stress to several health problems (e.g., Moffitt, 2013), including Parkinson's disease (in animal studies, e.g., Djamshidian & Lees, 2014;Sugama, et al, 2016), depression (e.g., Conway, Rutter & Brown, 2016;Gold, 2015;Swanson, Zeng, Weeks, & Colman, 2013) and pain (e.g., Hannibal & Bishop, 2014;Vachon-Presseau, 2013, Woda, Picard, & Dutheil, 2016. Stress was found to be associated with diminishing capacity to respond to reward (Admon, et al, 2013), declines in cognitive function (Vitaliano, et al, 2005) and disruptions in attentional control of the prefrontal cortex functions (Liston et al, 2009).…”

The exploration of mechanisms of comorbidity between migraine and depression

“…72 They showed that chronic stress can cause major depression and all types of chronic pain. 72 Chronic stress was a recognized risk factor for migraine and depression. 73 The interaction between depression and migraine can largely be explained as stressors that increase the risk of each other.…”

“…73 The interaction between depression and migraine can largely be explained as stressors that increase the risk of each other. 72 Stress, as a trigger, can lead to migraine attacks and magnify the frequency and shorten the interval. This research supports the idea that migraine can also be a source of stress, thereby leading to the amplification of the loop, as well as the idea that depression and anxiety also may be the stressors, as these conditions cause the imbalance of homeostasis.…”