Psychiatric comorbidities of chronic migraine in community and tertiary care clinic samples.

Although the association between episodic migraine and psychiatric comorbidities is well documented, few studies have focused on the comorbidity with chronic migraine (CM) and discrepancies exist between population-based and clinic-based data. The objective of this study is to compare demographic and psychiatric comorbidity correlates between CM samples drawn from the community and tertiary care. All inhabitants from a city borough were interviewed for the presence of headaches occurring 15 or more days per month. CM was diagnosed after subjects had been interviewed and examined by a headache doctor. Participants were also assessed with a structured interview by a psychiatrist, who assigned diagnoses based on the DSM-IV. The same investigators assessed all patients consecutively seen in a university-based outpatient headache center over a 4-month period. The samples consist of 41 individuals from the community and 43 from the headache center. Sociodemographic profiles were similar between groups with the exception of the mean number of years of formal education. Among individuals from the community, psychiatric diagnoses were present in 65.9 % of cases, relative to 83.7 % in those from the headache center (p = 0.06). Phobias (41.9 vs. 29.3 %) and depression (32.6 vs. 29.3 %) were more frequent in patients from the headache center, but this difference did not reach statistical significance. Thus the frequency of psychiatric disorders in patients with CM was elevated in both settings, being higher in the specialty care clinic.

Correlation between migraine subtypes and depression.

This study has evaluated depression in patients with episodic migraine (n=98), chronic migraine without medication overuse (n=23), and chronic migraine with medication overuse (n=57). The Beck Depression Inventory (BDI) was used to evaluate depressive symptoms in these three groups. The mean BDI score obtained in all patients was higher than that observed in asymptomatic subjects (episodic migraine=16.09+/-11.79, chronic migraine with medication overuse=18.91+/-12.53, chronic migraine without medication overuse=19.83+/-14.79). This finding corroborates previous studies suggesting a co-morbid association between migraine and depression. Depression did not seem to be crucial in the transformation of migraine as the median BDI scores did not differ significantly between patients with episodic and chronic migraine. The median BDI scores of the patients with chronic migraine with medication overuse and that patients with chronic migraine without medication overuse were similar as well. Therefore, medication overuse behavior may not be related with depression.

Obsessive compulsive disorder and migraine: case report, diagnosis and therapeutic approach.

Psychiatric disorders, notably mood and anxiety disorders, are frequently associated with migraine and chronic daily headaches. The obsessive-compulsive disorder (OCD) is included in the spectrum of anxiety disorders and may be a comorbid condition in headache patients. However, little information has been reported in the literature about this association. This is an important issue as OCD may contribute to the development or maintenance of treatment-resistant chronic headaches. In this paper, we describe a young female patient with refractory chronic migraine and OCD. Considerations on diagnosis, management and treatment of these comorbid conditions are presented.

Correlation between migraine subtipes and depression / Correlação entre subtipos de migrânea e depressão

This study has evaluated depression in patients with episodic migraine (n=98), chronic migraine without medication overuse (n=23), and chronic migraine with medication overuse (n=57). The Beck Depression Inventory (BDI) was used to evaluate depressive symptoms in these three groups. The mean BDI score obtained in all patients was higher than that observed in asymptomatic subjects (episodic migraine=16.09±11.79, chronic migraine with medication overuse=18.91±12.53, chronic migraine without medication overuse=19.83±14.79). This finding corroborates previous studies suggesting a co-morbid association between migraine and depression. Depression did not seem to be crucial in the transformation of migraine as the median BDI scores did not differ significantly between patients with episodic and chronic migraine. The median BDI scores of the patients with chronic migraine with medication overuse and that patients with chronic migraine without medication overuse were similar as well. Therefore, medication overuse behavior may not be related with depression.

Este estudo avaliou a depressão em pacientes com migrânea episódica (n=98), migrânea crônica com uso abusivo de analgésicos (n=57) e migrânea crônica sem uso abusivo de medicamentos analgésicos (n=23). O Inventário de Depressão de Beck (IDB) foi usado para avaliar sintomas depressivos nos três grupos. As médias dos escores de IDB encontradas (migrânea episódica=16.09±11.79, migrânea crônica com uso abusivo de analgésicos=18.91±12.53, migrânea crônica sem uso abusivo de analgésicos=19.83±14.79) foram maiores do que as observadas em indivíduos assintomáticos. Tais resultados confirmam estudos prévios indicando uma relação de comorbidade entre migrânea e depressão. Os dados não sugerem que a depressão seja um fator determinante da transformação da migrânea episódica em migrânea crônica, pois nestes dois grupos as medianas dos escores de IDB foram semelhantes. Os escores de IDB foram semelhantes entre os pacientes com migrânea crônica com e sem uso abusivo de analgésicos. Portanto, o comportamento de ingerir abusivamente analgésicos não parece estar relacionado com a depressão.