February 29, 2012 — Women who have migraines or a history of this headache disorder face a 36% increased risk of developing depression over the next 14 years, according to a new analysis of the Women's Health Study.
"We can't make a strong conclusion that if you had a migraine 20 years ago, you will still develop depression; that is too strong a statement," said senior author Tobias Kurth, MD, from Brigham and Women's Hospital, Boston, Massachusetts.
"All we can say is that a history of migraine is linkable with a future risk of developing depression and that risk does not seem to matter whether you have migraine with or without aura, or whether you have a history of migraine in the past, in general."
The study results were released February 22 and will be presented in April at the American Academy of Neurology 64th Annual Meeting in New Orleans, Louisiana.
Dr. Tobias Kurth
Similar Risks
Although previous studies have found an association between migraine and depression, researchers for this current study aimed to determine whether the link is more than shared chronic pain, Dr. Kurth said.
Another motivation was to shed more light on the pathophysiology and comorbid conditions of migraine, which is a common but under-recognized condition affecting about 18% of women and 6% of men, said Dr. Kurth.
The study included 36,154 women enrolled in the Women's Health Study who did not have a history of depression at baseline. At that time, 6456 women (17.86%) reported having active migraine with aura, active migraine without aura, or a past history of migraine (but not within the previous 12 months).
During a mean of 14.3 years of follow-up, 3971 women (10.98%) reported having physician-diagnosed depression.
Those with any history of migraine had 1.36 times the relative risk (RR) of developing depression compared with those without a history of migraine (95% confidence interval [CI], 1.27 - 1.47).
The risk was essentially the same for those with aura (RR, 1.43) or without aura (RR, 1.29). It also didn't seem to matter whether the migraines were current; women with a past history of migraine had 1.41 times the risk of developing depression (95% CI, 1.24 - 1.59).
Specific to Migraine?
Migraine is a painful condition affecting many aspects of a patient's life, including social interactions, so it's understandable that it may lead to depression. "But you could also envision that the pathomechanisms are similar" between migraine and depression, said Dr. Kurth.
"That's certainly a starting point for future research — Can we disentangle this information? Is it a chronic pain or is it just something very specific to migraineurs? Do patients with lower back pain have the same risk of depression or is it something that is specific to the migraine group?"
It's possible that the migraine/depression link involves neural mechanisms, perhaps neurotransmitters, said Dr. Kurth. "It could be that something being activated or not activated increases susceptibility to getting migraine and of getting depression. But I think what specific mechanisms these are is something we have to discuss with our colleagues in basic science."
Other research has suggested that the association between migraine and depression is bi-directional, said Dr. Kurth.
Men don't suffer migraine to the extent that women do, but the link with depression probably applies to them, too. "I don't see any good reason biologically why it would be limited to women," said Dr. Kurth.
One of the limitations of the study is that depression diagnosis was self-reported, so some cases may have been missed.
Study Size
Invited to comment, Joel Saper, MD, director, Head-Pain, Michigan Headache & Neurological Institute, Ann Arbor; clinical professor of neurology, Michigan State University; and past chair, headache section, American Academy of Neurology, said the study's sheer size separates it from past research that also linked depression with migraine.
"What makes this research different is that it's such a large study with such a long follow-up that it sort of confirms the lesser studies that we've assumed to be accurate."
Depression "tops the list" of comorbid conditions that have for several years been linked to migraine, said Dr. Saper. That list also includes anxiety, sleep disturbance, fibromyalgia, and irritable bowel syndrome.
The Women's Health Study is funded by the National Heart, Lung, and Blood Institute and the National Cancer Institute. Dr. Kurth and Dr. Saper have disclosed no relevant financial relationships.
American Academy of Neurology 64th Annual Meeting, New Orleans April 2012. Abstract #741.
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