Elsevier

General Hospital Psychiatry

Volume 31, Issue 1, January–February 2009, Pages 14-19
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
The relationship between migraine and mental disorders in a population-based sample

https://doi.org/10.1016/j.genhosppsych.2008.09.006Get rights and content

Abstract

Objective

There is emerging evidence from clinical and community samples to suggest that migraines are associated with mental disorders. The present study utilized a large population-based sample to investigate the association between physician-diagnosed migraine and mental disorders.

Method

Data were from the German Health Survey conducted between 1997 and 1999 (N=4181, response rate 61.4%, age 18–65 years). Lifetime and 12-month history of migraines were assessed by self-report and by a physician. Past 12-month DSM-IV mental disorders were assessed using the Composite International Diagnostic Interview.

Results

After adjusting for sociodemographic factors, past-year migraine was significantly and positively associated with depression, dysthymia, bipolar disorder, panic attacks, panic disorder, agoraphobia and simple phobia [adjusted odds ratios (AOR) ranging from 1.74 to 3.21]. After additionally adjusting for other mental disorders, any anxiety disorder (AOR=1.82) and any mood disorder (AOR=1.61) remained significantly associated with past-year migraine.

Conclusion

Although causal inferences cannot be made due to the cross-sectional nature of the data, the present study adds to a growing body of literature that suggests a strong association between migraines and mood and anxiety disorders.

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

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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.

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