Psychiatric–Medical ComorbidityThe relationship between migraine and mental disorders in a population-based sample☆
Introduction
An expanding body of literature has shown that migraine headaches are associated with higher rates of mental disorders. A recent review by Radat and Swendsen [1] examined the relationships between migraine and various mental disorders in community-drawn samples [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]. Breslau et al. [2] found significant associations between migraine and lifetime major depressive disorder, anxiety disorders, nicotine dependence, and alcohol or drug abuse and dependence. Merikangas et al. [4], [11] found that recurrent brief depression, panic disorder, phobia and generalized anxiety were more frequent among individuals with migraines than among individuals with tension headache or no headache. However, Merikangas et al. [4], [11] did not find an association between migraines and major depression, hypomania, or alcohol and drug abuse. Studies by Wang et al. [5] and Lipton et al. [6] found associations between migraine and depression. Most recently, using a longitudinal prospective design, Swartz et al. [3] demonstrated significant association between migraines and life-time major depression, panic disorder and phobia, after adjusting for age and sex. Their study did not find an association between migraine and alcohol or other substance abuse. A recent study, using the Canadian Community Health Survey, found migraine to be associated with major depressive disorder, bipolar disorder, panic disorder and social phobia [13]. In summary, there is inconsistency in the literature with respect to the type of mental disorders that are associated with migraines.
There are three main limitations to previous studies. First, many of the studies may be limited in their generalizability to the entire population by using cohorts that were healthier than the general population [2], [9], [10] or by using young adult [2], [4], [9], [10], [11] or elderly populations [5]. Second, many studies have only looked at a limited number of mental disorders [5], [6], [7], [8], [10], [12]. In particular, there is still conflicting opinion as to whether bipolar disorder, major depression and substance use disorders are associated with migraine [1]. Breslau et al. [2] found an association with bipolar disorder and alcohol abuse/dependence only for migraine with aura (no association between migraine without aura). Later, Breslau and Davis [9] again found an association between migraine and illicit drug use disorders. However, Swartz et al. [3] found no association between alcohol and other substance abuse and migraine after adjusting for age and sex. Jette et al. [13] did not find an association between migraine and alcohol or drug dependence either. Third, the conflicting findings of the relationship between migraines might be due to differences in methodology between studies on the assessment of migraines and mental disorders. The diagnoses of migraines in most community surveys have varied between self-reported diagnoses by health professional of migraines [13], [14], to lay interviewers utilizing the International Headache Society criteria for diagnosis of migraine conducted by lay interviewers [2], [3], [6], [7], [8], [9], [10]. The diagnoses of mental disorders have also varied between DSM-III, DSM-III-R and DSM-IV criteria.
To address these limitations, we utilized a unique survey — The German National Health Interview and Examination Survey — that specifically aimed to examine the relationship between physical conditions and mental disorders [15]. The strengths of this study were that migraines were diagnosed by a physician and that multiple DSM-IV-based mental disorders were evaluated by trained interviewers. The objective of this study was to determine whether migraine was associated with various mental disorders in a nationally representative sample.
Section snippets
Sample
The sample of this core survey was drawn from the population registries of subjects 18 to 79 years of age, living in Germany in 1997. It represents a stratified random sample from 113 communities throughout Germany with 130 sampling units. The first sampling step was the selection of communities; the second step was the selection of sampling units; and the third step was the selection of the inhabitants. As a result, a representative gross sample of 13,222 persons was eligible according to the
Results
Table 1 describes the prevalence of all the independent and dependent measures utilized in the current study. Mental disorders and migraine were both prevalent in the population. The prevalence of migraines in this study was found to be 11.7%; this is in keeping with previous representative population studies showing past-year prevalence rates of migraine from 9% to 15% [3], [13], [14], [20].
Table 2 shows the relationship between self-report and physician-diagnosed lifetime migraines. Although
Discussion
To the best of our knowledge, this is the first study to examine the relationship between physician-diagnosed migraine and multiple mental disorders in a nationally representative sample. The strengths of this study include a large sample size, a standardized interview (CIDI) and physician-diagnosed physical health problems. The present study overcomes an important limitation of previous studies that relied upon self-report diagnosis of migraines.
The present study's findings show a consistent
References (34)
- et al.
Migraine, psychiatric disorders, and suicide attempts: an epidemiologic study of young adults
Psychiatry Res
(1991) - et al.
Headache syndromes and psychiatric disorders: Association and familial transmission
J Psychiatr Res
(1993) - et al.
Comorbidity of headaches and depression in the elderly
Pain
(1999) - et al.
Migraine, physical health and psychiatric disorder: a prospective epidemiologic study in young adults
J Psychiatr Res
(1993) - et al.
Diagnosing major depression in the elderly: evidence for response bias in standardized diagnostic interviews?
J Psychiatr Res
(1994) - et al.
Differential H-imipramine platelet binding in patients with panic disorder and depression
Psychiatry Res
(1987) - et al.
Platelet serotonin uptake in panic disorder
J Affect Disord
(1986) - et al.
Psychiatric morbidity, platelet monoamine oxidase and tribulin output in headache
Psychiatry Res
(1989) - et al.
Migraine and depression: Association and familial transmission
J Psychiatr Res
(1988) - et al.
Psychiatric comorbidity in migraine: a review
Cephalalgia
(2004)
Mental disorders and the incidence of migraine headaches in a community sample
Arch Gen Psychiatry
Migraine, quality of life and depression. A population-based case control study
Neurology
Headache and major depression. Is the association specific to migraine?
Neurology
Headache types and panic disorder
Neurology
Migraine and major depression
Headache
Psychopathology and headache syndromes in the community
Headache
Anxiety and depression in migraine
J R Soc Med
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The authors have no conflicts of interest. Preparation of this article was supported by (1) a CIHR New Investigator grant (#152348) awarded to Dr. Sareen, (2) a Manitoba Health Research Council Studentship awarded to Ms. Belik and (3) a Western Regional Training Centre studentship funded by Canadian Health Services Research Foundation, Alberta Heritage Foundation for Medical Research and Canadian Institutes of Health Research awarded to Ms. Belik.