Relationship of intensity and special characteristics of migraine to depressive and anxious features.

Mood and pain are interrelated to each other in a mutual and complex manner. Patient populations in headache clinics exhibit more emotional disturbance than general practice patients. Nonetheless, the degree of psychological illness among headache patients is less than maybe found in psychiatric outpatients. However, it is a fact that several psychiatric disorders appear to be comorbid with primary headache syndromes such as migraine. Still, prospective standardized studies are sparse. We aimed to investigate whether migraine per se or specific migraine characteristics are associated to depression and anxiety. In a single center study (Department of Neurology of the University of Athens) migraineurs were asked for several headache features such as pain intensity, attack frequency, average attack duration, prodromal symptoms and the presence of aura. We assessed 50 consecutive headache patients who were referred to our headache outpatient clinic. Patients diagnosed with non-migraine syndromes, mixed non-migraine and migraine syndromes, or patients with previously diagnosed systemic disease known to precipitate psychiatric disorders (such as systemic lupus erythematodes) were excluded from the study. Furthermore, we did not include any subjects who were already on antidepressive or other psychiatric medication. Twenty four patients met the inclusion criteria. The data were then correlated with scores obtained by the Beck Depression Inventory and the Hamilton's scales for Depression and Anxiety. Our results showed an increased frequency of mild and moderate depression compared to what was expected from the normal population which is in line with past observations on headache patients. In an analogous manner, mild and moderate anxiety appeared more frequently among migraineurs than healthy subjects. However, we did not find any significant relation between depression or anxiety and parameters such as pain intensity, monthly attack frequency, attack duration, presence or absence of aura, appearance of pre-ictal prodromal symptoms and migraine career duration (age of assessment minus age of migraine onset). These findings suggest that migraine, although often comorbid with depression and anxiety, has no specific headache characteristics causally related to mood abnormalities. Larger samples will be required in future studies to address the question of a link between more specific mood and mental disturbances with primary headache syndromes.