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Comorbidity of Migraine, Major Depressive Disorder, and Generalized Anxiety Disorder in Adolescents and Young Adults

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Abstract

Purpose

Depression and anxiety are highly comorbid psychiatric conditions and both are common in adult patients with migraine. This study aims to examine the unique associations between major depressive disorder (MDD) and generalized anxiety disorder (GAD) in a well-characterized group of older adolescents and college-age individuals with migraine.

Method

Participants (N =  227), between 15 and 20 years old, who were unmedicated or within 1 month of beginning antidepressant treatment underwent a comprehensive psychiatric assessment to establish the presence of MDD and GAD, according to the Diagnostic and Statistical Manual, Fourth Edition, Text Revision, and to rate their symptom severity using the Longitudinal Interval Follow-up Evaluation for Adolescents (A-LIFE). They then completed the ID-Migraine. The Student’s t test and chi-square test were used to compare continuous and categorical variables, respectively, across participants with vs. without migraine. Logistic regression analysis examined the association between the presence of migraine and psychopathology.

Results

A diagnosis of MDD was associated with significantly increased risk of having migraine. Moreover, more severe and persistent ratings of depression were associated with an even higher likelihood of having migraine. A diagnosis of GAD was also significantly associated with the presence of migraine. The prevalence of comorbid MDD and GAD was significantly higher in participants with migraine than those without migraine (55 vs. 22%, p < 0.0001). When examined concurrently, GAD remained significantly associated with migraine, with a statistical trend for MDD to be associated with it.

Conclusion

The comorbidity of migraine, MDD, and GAD has important clinical and research implications. Patients who suffer from any of these problems should be screened for all three in order to receive comprehensive care. Shared psychological and biological vulnerabilities may be involved in the three conditions. Greater understanding of the shared vulnerabilities can lead to unified treatments.

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Notes

  1. This study was launched in 2010, well before the DSM-5 became available, and new patient enrollment also ended before DSM-5 was released. The diagnostic criteria for major depression and GAD were not substantially modified in DSM-5.

  2. Migraine is more prevalent in females than in males. The prevalence of migraine also varies by age. Thus, we adjusted for these two necessary variables. Adjusting for SSRI use was undertaken in the relevant analyses to confirm that migraine/SSRI-induced headaches were not conflated by this confounder.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, D.C.: American Psychiatric Association; 2000.

    Google Scholar 

  2. Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet. 2012;379:1056–67.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49:980–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Smitherman TA, McDermott MJ, Buchanan EM. Negative impact of episodic migraine on a university population: quality of life, functional impairment, and comorbid psychiatric symptoms. Headache. 2011;51:581–9.

    Article  PubMed  Google Scholar 

  5. Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol. 2010;52:1088–97.

    Article  PubMed  Google Scholar 

  6. Antonaci F, Nappi G, Galli F, Manzoni GC, Calabresi P, Costa A. Migraine and psychiatric comorbidity: a review of clinical findings. The journal of headache and pain. 2011;12:115–25.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Radat F, Swendsen J. Psychiatric comorbidity in migraine: a review. Cephalalgia : an international journal of headache. 2005;25:165–78.

    Article  CAS  Google Scholar 

  8. Bektas O, Ugur C, Gencturk ZB, Aysev A, Sireli O, Deda G. Relationship of childhood headaches with preferences in leisure time activities, depression, anxiety and eating habits: a population-based, cross-sectional study. Cephalalgia: an international journal of headache. 2015;35:527–37.

    Article  Google Scholar 

  9. Lu SR, Fuh JL, Wang SJ, Juang KD, Chen SP, Liao YC, Wang YF. Incidence and risk factors of chronic daily headache in young adolescents: a school cohort study. Pediatrics. 2013;132:e9–e16.

    Article  PubMed  Google Scholar 

  10. Pakalnis A, Gibson J, Colvin A. Comorbidity of psychiatric and behavioral disorders in pediatric migraine. Headache. 2005;45:590–6.

    Article  PubMed  Google Scholar 

  11. Yacob D, Di Lorenzo C, Bridge JA, Rosenstein PF, Onorato M, Bravender T, Campo JV. Prevalence of pain-predominant functional gastrointestinal disorders and somatic symptoms in patients with anxiety or depressive disorders. J Pediatr. 2013;163:767–70.

    Article  PubMed  Google Scholar 

  12. Bellini B, Arruda M, Cescut A, Saulle C, Persico A, Carotenuto M, Gatta M, Nacinovich R, Piazza FP, Termine C, Tozzi E, Lucchese F, Guidetti V. Headache and comorbidity in children and adolescents. The journal of headache and pain. 2013;14:79.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Arruda MA, Bigal ME. Behavioral and emotional symptoms and primary headaches in children: a population-based study. Cephalalgia : an international journal of headache. 2012;32:1093–100.

    Article  Google Scholar 

  14. Balottin U, Chiappedi M, Rossi M, Termine C, Nappi G. Childhood and adolescent migraine: a neuropsychiatric disorder? Med Hypotheses. 2011;76:778–81.

    Article  PubMed  Google Scholar 

  15. Kowal A, Pritchard D. Psychological characteristics of children who suffer from headache: a research note. Journal of child psychology and psychiatry, and allied disciplines. 1990;31:637–49.

    Article  CAS  PubMed  Google Scholar 

  16. Laurell K, Larsson B, Eeg-Olofsson O. Headache in schoolchildren: association with other pain, family history and psychosocial factors. Pain. 2005;119:150–8.

    Article  PubMed  Google Scholar 

  17. Calarge CA, Butcher BD, Burns TL, Coryell WH, Schlechte JA, Zemel BS. Major depressive disorder and bone mass in adolescents and young adults. J Bone Miner Res. 2014;29(10):2230–7.

    Article  PubMed  Google Scholar 

  18. Coryell WH, Butcher BD, Dindo LN, Schlechte JA and Calarge CA. Fat distribution and major depressive disorder in late adolescence. J Clin Psychiatry. In Press.

  19. Deumic E, Butcher BD, Clayton AD, Dindo LN, Burns TL, Calarge CA. Sexual functioning in adolescents with major depressive disorder. J Clin Psychiatry. 2016;77(7):957–62.

    Article  PubMed  Google Scholar 

  20. Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME. NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry. 2000;39:28–38.

    Article  CAS  PubMed  Google Scholar 

  21. Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chiappetta L, Ryan N, Leonard H, Hunt J, Iyengar S, Keller M. Clinical course of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry. 2006;63:175–83.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lipton RB, Dodick D, Sadovsky R, Kolodner K, Endicott J, Hettiarachchi J. Harrison W and study IDMv. A self-administered screener for migraine in primary care: The ID Migraine validation study Neurology. 2003;61:375–82.

    CAS  PubMed  Google Scholar 

  23. Zarifoglu M, Karli N, Taskapilioglu O. Can ID Migraine be used as a screening test for adolescent migraine? Cephalalgia : an international journal of headache. 2008;28:65–71.

    Article  CAS  Google Scholar 

  24. Bicakci S, Bozdemir N, Over F, Saatci E, Sarica Y. Prevalence of migraine diagnosis using ID Migraine among university students in southern Turkey. The Journal of Headache and Pain. 2008;9(3):159–63.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Oztora S, Korkmaz O, Dagdeviren N, et al. Migraine headaches among university students using id migraine test as a screening tool. BMC Neurol. 2011;11:103.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 2002;109:45–60.

    Article  PubMed  Google Scholar 

  27. McWilliams LA, Goodwin RD, Cox BJ. Depression and anxiety associated with three pain conditions: results from a nationally representative sample. Pain. 2004;111:77–83.

    Article  PubMed  Google Scholar 

  28. Loder E, Burch R, Rizzoli P. The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache. 2012;52(6):930–45.

    Article  PubMed  Google Scholar 

  29. Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ. Canadian headache society prophylactic guidelines development group. Canadian headache society guideline for migraine prophylaxis. Can J Neurol Sci. 2012;39(2 Suppl 2):S1–59.

    PubMed  Google Scholar 

  30. Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E. Quality standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the quality standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1337–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Ozyalcin SN1, Talu GK, Kiziltan E, Yucel B, Ertas M, Disci R. The efficacy and safety of venlafaxine in the prophylaxis of migraine. Headache 45(2):144–152, 2005.

  32. Tarlaci S. Escitalopram and venlafaxine for the prophylaxis of migraine headache without mood disorders. Clin Neuropharmacology. 2009;32(5):254–8.

    Article  CAS  Google Scholar 

  33. Gelfand AA. Psychiatric comorbidity and paediatric migraine: examining the evidence. Curr Opin Neurol. 2015;28:261–4.

    Article  PubMed  Google Scholar 

  34. Buse DC, Andrasik F. Behavioral medicine for migraine. Neurol Clin. 2009;27:445–65.

    Article  PubMed  Google Scholar 

  35. Cahill CM, Murphy KC. Migraine: another headache for psychiatrists? Br J Psychiatry. 2004;185:191–3.

    Article  PubMed  Google Scholar 

  36. Bigal ME, Lipton RB. Modifiable risk factors for migraine progression. Headache. 2006;46:1334–43.

    Article  PubMed  Google Scholar 

  37. Breslau N, Lipton RB, Stewart WF, Schultz LR, Welch KM. Comorbidity of migraine and depression: investigating potential etiology and prognosis. Neurology. 2003;60:1308–12.

    Article  CAS  PubMed  Google Scholar 

  38. Merikangas KR, Angst J, Isler H. Migraine and psychopathology. Results of the Zurich cohort study of young adults Arch Gen Psychiatry. 1990;47:849–53.

    CAS  PubMed  Google Scholar 

  39. Asmundson GJ, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry. 2002;47:930–7.

    PubMed  Google Scholar 

  40. Chiros C, O'Brien WH. Acceptance, appraisals, and coping in relation to migraine headache: an evaluation of interrelationships using daily diary methods. J Behav Med. 2011;34:307–20.

    Article  PubMed  Google Scholar 

  41. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44:1–25.

    Article  PubMed  Google Scholar 

  42. Dindo L, Recober A, Marchman J, O'Hara M, Turvey C. Depression and disability in migraine: the role of pain acceptance and values-based action. International journal of behavioral medicine. 2015;22:109–17.

    Article  PubMed  Google Scholar 

  43. Dindo L, Recober A, Marchman J, O'Hara MW, Turvey C. One-day behavioral intervention in depressed migraine patients: effects on headache. Headache. 2014;54:528–38.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Hayes SC, Pistorello J, Levin ME. Acceptance and commitment therapy as a unified model of behavior change. Couns Psychol. 2012;40:976–1002.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA

    Lilian N. Dindo

  2. Michael Debakey Veterans Affairs, Health Services Research and Development, Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA

    Lilian N. Dindo

  3. Department of Neurology, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA

    Ana Recober

  4. Department of Psychiatry, Washington University, Seattle, USA

    Rita Haddad

  5. Menninger Department of Psychiatry and Behavioral Sciences, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 1102 Bates Ave, Suite 790, Houston, TX, 77030, USA

    Chadi A. Calarge

Authors
  1. Lilian N. Dindo
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  2. Ana Recober
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  3. Rita Haddad
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  4. Chadi A. Calarge
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Corresponding authors

Correspondence to Lilian N. Dindo or Chadi A. Calarge.

Ethics declarations

Funding

This work was funded by the National Institute of Mental Health (R01MH090072) and the National Center for Research Resources (2UL1TR000442-06) to the senior author C.C. It was also funded by the National Institute of Mental Health (K23MH097827) and was partially supported with resources and the use of facilities at the Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN13-413) to the first author L.D.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies, the Department of Veterans Affairs, the US government, or Baylor College of Medicine. The funding agencies had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review or approval of the manuscript. The authors are grateful for the contributions of the participants and their families as well as for those of the research team.

Aspects of this work have been accepted for presentation at the Annual Meeting of the American Academy of Child and Adolescent Psychiatry, on October 29, 2015, in San Antonio, TX.

ClinicalTrials.gov Identifier: NCT02147184.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the University of Iowa Institutional Review Board.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Dindo, L.N., Recober, A., Haddad, R. et al. Comorbidity of Migraine, Major Depressive Disorder, and Generalized Anxiety Disorder in Adolescents and Young Adults. Int.J. Behav. Med. 24, 528–534 (2017). https://doi.org/10.1007/s12529-016-9620-5

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  • DOI: https://doi.org/10.1007/s12529-016-9620-5

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