I should have been skeptical as well as astonished by the study finding that women with severely disabling migraine and other severe symptoms have a 32 times greater risk of depression — because it’s not accurate.
The Washington Post reported: “The women with a diagnosis of severely disabling migraine had a 32-fold increased risk of major depression if they also reported other severe symptoms.” It did not include that this was only the case for participants with chronic migraine.
The key points to note:
These findings are specifically about migraine, not chronic headache in general.
Chronic is defined as having headaches 15 or more days per month.
Severe disability refers to a score on the Headache Impact Test-6 of 60 or higher. For reference, today my HIT-6 score was 64. (It’s an interesting test that only takes a couple minutes. If you don’t want to register, use BugMeNot for a user name and password.)
Other severe symptoms refers to a participant’s score on Patient Health Questionnaire-15, a test of physical symptoms, like nausea, indigestion, dizziness, fatigue, back pain and trouble sleeping.
So, women in this study who had migraine (not headaches in general) that was chronic and had severe physical symptoms were 32 times more likely to have major depression. It’s important to note that the study didn’t take medication use into account. Whether the participants were taking antidepressants or not would affect the results.
For more, accurate findings from the study, see Migraine Linked to Greater Risk for Major Depression, Chronic Physical Symptoms, from Medscape. (You’ll need a password, which you can get from BugMeNot.)
Thanks to Dr. Christina Peterson for pointing out the error in my original post on the topic. She provided me with a wealth of information on the study and many other resources on headache and depression. As always, I value her input, which makes The Daily Headache a better blog.
4 thoughts on “Women, Chronic Migraine & Depression”
But neurology is never boring! We never run out of new territory to explore. It’s a never-ending adventure. 🙂
That’s my take on it too (and I told him so). 😀
Well, actually, the authors sort of do and sort of don’t talk about a symbiotic relationship. It depends on how you look at it.
The way it’s phrased is that they see a “synergistic relationship” between severe headache-related disability, multiple physical symptoms, and major depressive disorder. And they hypothesize that that synergistic relationship is serotonergic. So–brain-based. But, to me, all depression is brain-based. Isn’t it?
And given that recent studies of depression and anti-depressants have shown that untreated depression changes brain structure, it all gets a bit murky.
I should also mention that there are many types of serotonin receptors in the brain, and that the migraine serotonin receptors are a different type than the ones that anti-depressants bind to. Of interest is that there are yet other types of serotonin receptors associated with nausea.
So–when the authors state that they hypothesize that severe headache, severe somatic symptoms, and major depression may be linked through dysfunction of the serotonergic system, and that studies are underway to test that theory, that covers a lot of territory.
It’s very complex. Sometimes, it seems like the more we study some of this, the more complex it becomes.
I’ve been curious about the connection between serotonin and headaches. I didn’t realize that there were different kinds of serotonin receptors.
A friend of mine who is a gastroenterologist told me recently that he’d hate to be a neurologist because the territory is so vast and (to his mind) illnesses are easily treated. I can see what he means. New information is always just around the corner and it does seem like each new bit adds another layer of complexity.
odd…when you first posted about this study I replied to it, but it looks like there was a glitch because my reply isn’t there. I had tried to post that my local news station reported on that study that night as well, except their focus was much different. They reported that people with migraine and especially with chronic migraine (and they defined that as 15 or more days per month) had a higher incidence of chronic illness overall, and one of those illnesses includes depression. So basically depression wasn’t their only focus which was nice for once. It was however highlighted both because the data showed such high numbers, and I assume because of the following…
Regarding the depression link, they said that the researchers (from the study) are going to be investigating whether or not a “common brain chemical is involved in both migraine and depression”, which I thought was a *very* refreshing shift in focus in the often symbiotic relationship involved between these two illnesses for some people. SO MANY people automatically assume that oh well, ya know, pain gets ya down and it’s common sense that you’d get depressed. It’s often far more complicated than that.
Thanks for sharing the information from the news station. I’ve only had access to some parts of the journal article, so I didn’t see this. Previous research has shown that a lot of illnesses are co-morbid. That is, if someone has one illness (like migraine) than they are more likely to have another (like depression, epilepsy or fibromyalgia).
There has been a lot of research on depression and migraine. Dr. Peterson sent me a lot of information about this, which I hope to post on soon.
Thanks for the link to the HIT-6. I scored a 69, which confirms for me that it’s a good idea to see my doc this week! I have an appointment on Thursday…
Yikes! Good luck at your appointment.