Associations Between Depression/Anxiety and Headache Frequency in Migraineurs

A Cross-Sectional Study

Hsuan-Te Chu, MD; Chih-Sung Liang, MD; Jiunn-Tay Lee, MD; Ta-Chuan Yeh, MD; Meei-Shyuan Lee, PhD; Yueh-Feng Sung, MD, PhD; Fu-Chi Yang, MD, PhD


Headache. 2018;58(3):407-415. 

In This Article


Subject Characteristics

Demographic and clinical characteristics of the nonmigraine control and migraine groups are presented as the observational data and summarized in Table 1. Among the 409 subjects with migraines, 129 (31.5%) reported experiencing preattack auras. No group associated trends in distribution of auras, gender, age, BMI, employment, alcohol consumption, or coffee consumption emerged. Moreover, higher frequency of migraine attacks correlated with higher scores on the MIDAS, PSQI, and BDI, as well as higher subscores on the anxiety and depression portions of the HADS (all P < .001). Subjects with chronic migraines (≥15 hd/months) were slightly less educated than the other groups (P = .044) and subjects in the nonmigraine control group were less likely to smoke than subjects in the migraine groups (P = .001).

Effect of Migraine Frequency on BDI and HADS Scores

BDI and HADS score data derived from multivariable linear regression analysis are reported in Table 2 and associated means are shown in Figure 1. Trend tests indicated that migraine frequency was associated with BDI total score (P = .001), as well as HADS anxiety (P = .002) and depression (P < .001) subscores after adjusting for subject characteristics. These associations persisted regardless of the presence or absence of auras.

Figure 1.

Median and interquartile ranges of means for outcome variables across the study groups. (A) BDI total score, (B) HADS anxiety, and (C) HADS depression.

Factors Associated With BDI and HADS Scores

The results of multivariable linear regression analyses investigating factors associated with BDI and HADS scores are reported in Table 3. Subjects in all four migraine groups had higher BDI and HADS scores than the nonmigraine control group, with the exception of the HADS depression subscore comparison between the 5–8 hd/months and nonmigraine control groups (P = .052). Poor sleep quality (PSQI total score ≥ 6) was also associated with high BDI and HADS scores. In addition, alcohol consumption emerged as an independent factor of BDI total score (P = .035).