Depression Prevalence High in Transformed Migraine

BY ALICIA AULT
Elsevier Global Medical News

CHICAGO (EGMN) - Depression prevalence may be as high as 30% in transformed migraine, according to a preliminary analysis of the American Migraine Prevalence and Prevention study presented on June 8 at the annual meeting of the American Headache Society.

By contrast, only 6%-7% of the U.S. general population has depression, said Dawn C. Buse, Ph.D., director of psychology at the Montefiore Headache Center at the Montefiore Medical Center in New York. Dr. Buse presented the analysis on behalf of colleagues at the Albert Einstein College of Medicine, New York; Vedanta Research in Chapel Hill, N.C.; and the Diamond Headache Clinic in Chicago.

The American Migraine Prevalence and Prevention (AMPP) study is an ongoing multisite survey that began in 2004 when a random sample of 120,000 households was mailed self-administered headache questionnaires. Of the 162,576 individuals who responded, 30,721 self-reported severe headaches. A follow-up survey was sent in 2005 to a random subsample of 24,000 of the headache sufferers.

The data presented by Dr. Buse came from the follow-up survey. Respondents were asked to report body mass index (BMI), and to respond to the Migraine Disability Assessment (MIDAS) questionnaire and the Patient Health Questionnaire-Nine Item Depressive Scale (PHQ-9).

The goal was to determine the relationship between depression, headache type, BMI, and disability. Data were analyzed from 3,840 (16%) respondents whose scores placed them in the moderately severe or severe major depression category.

Depression rates were highest in patients with transformed migraine, at 30% (1,152 patients), followed by chronic daily headache at about 20% (768 patients). Eighteen percent (691) of migraine patients had depression, followed by 15% (576) of other types of headache, 13% (500) of tension headache and 12% (461) of probable migraine.

Among patients with depression, 25% were morbidly obese, while 19% were underweight, said Dr. Buse. She and her colleagues could not determine from their data whether these below-normal weight respondents were anorexic or bulimic, she said.

Depression increased with rising disability. Only 11% of depressed patients had MIDAS grade 1 disability, compared with 33% of those with MIDAS grade 4 disability, said Dr. Buse.

Because AMPP is a cross-sectional study, it cannot get at the mechanisms for these interrelationships, she said, adding that she and her colleagues currently are collecting data on medications used, psychiatric and other comorbidities, and will be following this population for at least another survey, so there may be opportunities for cause-effect analyses in the future.

The AMPP study was supported by the National Headache Foundation through a grant from Ortho-McNeil. Dr. Buse reported that that she consults for Ortho-McNeil and Allergan Pharmaceuticals.

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