The Effect of Psychiatric Comorbidities on Headache‐Related Disability in Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study

Abstract

Objective To examine the influences of depression and anxiety on headache‐related disability in people with episodic migraine or chronic migraine. Background Depression and anxiety are common comorbidities in people with migraine, especially among those with chronic migraine. Methods This cross‐sectional analysis of data from the longitudinal, internet‐based Chronic Migraine Epidemiology and Outcomes Study assessed sociodemographic and headache features, and headache‐related disability (Migraine Disability Assessment Scale). Four groups were defined based on scores from validated screeners for depression (9‐item Patient Health Questionnaire) and anxiety (7‐item Generalized Anxiety Disorder Scale): depression alone, anxiety alone, both, or neither. Results Respondents (N = 16,788) were predominantly women (74.4% [12,494/16,788]) and white (84.0% [14,044/16,788]); mean age was 41 years. Depression was more likely in persons with chronic migraine vs episodic migraine (56.6% [836/1476] vs 30.0% [4589/15,312]; P < .001), as were anxiety (48.4% [715/1476] vs 28.1% 4307/15,312]; P < .001) and coexisting depression and anxiety (42.0% [620/1476] vs 20.8% [3192/15,312]; P < .001). After controlling for headache frequency and other covariates, depression alone, and anxiety alone were associated with 56.0% (rate ratio [RR], 1.56; 95% confidence interval [CI], 1.46‐1.66) and 39.0% (RR, 1.39; 95% CI, 1.30‐1.50) increased risks of moderate/severe migraine‐related disability (both P < .001), respectively; the combination had an even greater effect on risk of moderate/severe disability (79.0% increase; RR, 1.79; 95% CI, 1.71‐1.87; P < .001). Conclusions Depression alone and anxiety alone are associated with greater headache‐related disability after controlling for sociodemographic and headache features. Coexisting depression and anxiety are more strongly associated with disability than either comorbidity in isolation. Interventions targeting depression and anxiety as well as migraine itself may improve headache‐related disability in people with migraine.

Demographics, Headache Features, and Comorbidity Profiles in Relation to Headache Frequency in People With Migraine: Results of the American Migraine Prevalence and Prevention (AMPP) Study

“…Differences were also significant between the CM group and the HFEM group, though the magnitude of the difference was much larger for the HFEM vs L/MFEM groups. As MHDs increase, it has been previously demonstrated that MIDAS scores increase 33,34 . It is, therefore, plausible that differences in disability are a consequence of increased MHDs.…”

“…As MHDs increase, it has been previously demonstrated that MIDAS scores increase. 33,34 It is, therefore, plausible that differences in disability are a consequence of increased MHDs. There were no significant differences in headache impact as measured by the proportion requiring bed rest during a typical migraine attack between the pairs of groups we contrasted.…”

Understanding the migraine treatment landscape prior to the introduction of calcitonin gene‐related peptide inhibitors: Results from the Assessment of TolerabiliTy and Effectiveness in MigrAINe Patients using Preventive Treatment (ATTAIN) study

“…5 Impacts on family and social life, difficulty making plans or commitments, and emotional/affective and cognitive distress are also common among migraine patients. [6][7][8] naïve group and 12.4 days (SD = 7.0) for treatment experienced patients. The majority had severe Migraine Disability Assessment (Grade IV, total score ≥21), including 67.1% Conclusions: Prior to 2018, the burden of migraine was high for patients initiating preventive treatments.…”

“…Migraine‐related disability impacts productivity at work, school, and functioning at home 5 . Impacts on family and social life, difficulty making plans or commitments, and emotional/affective and cognitive distress are also common among migraine patients 6–8 …”

Improvements in quality of life and work productivity with up to 6 months of fremanezumab treatment in patients with episodic and chronic migraine and documented inadequate response to 2 to 4 classes of migraine‐preventive medications in the phase 3b FOCUS study

“…Depression was among the most commonly reported comorbid conditions in a survey of patients with migraine (63.8%) 9 . Longitudinal research demonstrates that depression among migraine patients is associated with a 56% greater risk of moderate/severe migraine‐related disability 10 . Consequently, patient‐reported outcomes (PROs) are a critical component of evaluating the effects of new treatments on HRQoL, emotional and psychological well‐being, disability status, and occupational functioning 11 .…”