The impact of remission and coexisting migraine on anxiety and depression in cluster headache

Abstract

Background: Our aim was to investigate the relationship between coexisting cluster headache (CH) and migraine with anxiety and depression during active cluster bouts, and how symptoms change during remission. Methods: We analyzed data from 222 consecutive CH patients and 99 age-and sex-matched controls using a prospective multicenter registry. Anxiety or depression was evaluated using the Generalized Anxiety Disorder-7 (GAD-7) or Patient Health Questionnaire-9 (PHQ-9), respectively. Moderate-to-severe anxiety or depression was defined as a score of ≥10 at baseline (during a cluster bout). We assessed for changes in anxiety and depression during CH remission periods. Results: Among the CH patients, the prevalence of moderate-to-severe anxiety and depression was seen in 38.2% and 34.6%, respectively. Compared with controls, CH patients were associated with moderate-to-severe anxiety and depression (multivariable-adjusted odds ratio [aOR] = 7.32, 95% confidence intervals [CI] = 3.35-15.99 and aOR = 4.95, 95% CI = 2.32-10.57, respectively). CH patients with migraine were significantly more likely to have moderate-tosevere anxiety and depression (aOR = 32.53, 95% CI = 6.63-159.64 and aOR = 16.88, 95% CI = 4.16-68.38, respectively), compared to controls without migraine. The GAD-7 and PHQ-9 scores were significantly reduced between cluster bout and remission periods (from 6.8 ± 5.6 to 1.6 ± 2.8; P < 0.001, and from 6.1 ± 5.0 to 1.8 ± 2.4; P < 0.001, respectively). Conclusions: Our results indicate that CH patients are at increased risk of anxiety and depression, especially in the presence of coexisting migraine. However, the anxiety and depression can improve during remission periods.

Clinical features of cluster headache without cranial autonomic symptoms: results from a prospective multicentre study

“…It has been consistently reported that individuals with CH have a higher frequency of anxiety and depression than those with migraine or without headache 10 , 23 – 27 . Additionally, it has been demonstrated that individuals with CCH are more likely to be affected by anxiety and depression than those with ECH 10 . High frequencies of anxiety and depression were observed in the CH and PCH groups in the present study.…”

“…Detailed information about the KCHR has been described previously 5 , 10 . In the KCHR, participants fulfilling the available diagnostic criteria for CH and PCH, the third edition beta version of the International Classification of Headache Disorders (ICHD-3 beta), at the time it was created were enrolled 11 .…”

Clinical Features of Cluster Headache without Cranial Autonomic Symptoms: Results from a Prospective multicentre study

“…It has been consistently reported that individuals with CH have a higher frequency of anxiety and depression than those with migraine or without headache [10,[20][21][22][23][24]. Additionally, it has been demonstrated that individuals with CCH are more likely to be affected by anxiety and depression than those with ECH [10].…”

“…Detailed information about the KCHR has been described previously [5,10]. In the KCHR, participants ful lling the diagnostic criteria for CH and PCH based on the beta version of the ICHD-3 (ICHD-3 beta), the available diagnostic criteria at the time, were enrolled.…”

Cluster Headache is Still Lurking in the Shadows

“…The pathogenesis of this disease is, at the current state of knowledge, based on the derangement of the complex interactions existing between the trigeminovascular system activating the trigeminal-autonomic reflex, leading to the release of specific neuropeptides like calcitonin gene-related peptides (CGRP) and pituitary adenylate cyclase-activating polypeptide 38 (PACAP-38), and its interactions with a deranged (putative) hypothalamic control center [5,6]. Further multiple basic and clinical research approaches have added important information on the role of neurosteroids, neuroimaging and neurophysiology data, sleep disorders, and psychiatric comorbidities in this still not completely clear pathophysiological picture of CH [7][8][9][10].…”