Longitudinal associations of migraine and depressive symptoms: a cohort analysis.

BACKGROUND: While the association between migraine and depression has been well established, there is very little information as to whether effective prophylactic treatment of migraine correlates with improvement in comorbid depression. METHODS: We analyzed initial visit data from migraine headache patients (n = 961) in the Mayo Headache Registry along with follow-up data (n = 389) from a subset of this cohort. Depressive symptoms were measured utilizing the Beck Depression Inventory II (BDI-II). RESULTS: We found a correlation between BDI-II and migraine frequency for 4 weeks and 3 months prior to the initial visit (Spearman correlation coefficient ρ = 0.335 and 0.349, respectively; p value < 0.0001 for both). There was a similar albeit weaker correlation between BDI-II vs. migraine intensity over the same periods prior to initial consultation (ρ = 0.147 and 0.170, respectively; p value < 0.0001 for both). However, there was not a significant difference in BDI-II scores for subjects with aura vs. without aura (p value = 0.12). Among those with follow-up, improvement in BDI-II correlated with a reduction in migraine frequency and intensity (p value = 0.016 and 0.089, respectively). Differences in the degree of improvement of BDI-II score in patients treated with amitriptyline vs. topiramate could not be detected (p = 0.36). CONCLUSIONS: BDI-II score was associated with migraine measures but not with the presence of aura at time of clinical presentation. Over follow-up time, an improvement in depression score was correlated with a reduction in migraine frequency, but was not significantly associated with medication type.

Chronic pain rehabilitation in chronic headache disorders.

This article reviews the treatment goals and efficacy of comprehensive pain rehabilitation programs for the treatment of chronic headache. Substantial data demonstrate improved outcomes from rehabilitative treatment for chronic noncancer pain. We present a discussion of the most relevant recent publications on pain rehabilitation in chronic headache disorders. This article describes pain rehabilitation, reviews outcome data for chronic pain patients treated in this setting, and describes the unique applicability of this treatment approach for patients with chronic headache. Particular attention is directed to the rationale for and the results of the withdrawal, in a pain rehabilitation setting, of opioids and simple analgesics, ergots, and triptans that contribute to medication overuse headaches. Additionally, a case example is reviewed that illustrates the structure and function of a pain rehabilitation program in the treatment of a patient with intractable headache.

Chronic pain rehabilitation in chronic headache disorders.

This article reviews the treatment goals and efficacy of comprehensive pain rehabilitation programs for the treatment of chronic headache. Substantial data demonstrate improved outcomes from rehabilitative treatment for chronic noncancer pain. We present a discussion of the most relevant recent publications on pain rehabilitation in chronic headache disorders. This article describes pain rehabilitation, reviews outcome data for chronic pain patients treated in this setting, and describes the unique applicability of this treatment approach for patients with chronic headache. Particular attention is directed to the rationale for and the results of the withdrawal, in a pain rehabilitation setting, of opioids and simple analgesics, ergots, and triptans that contribute to medication overuse headaches. Additionally, a case example is reviewed that illustrates the structure and function of a pain rehabilitation program in the treatment of a patient with intractable headache.