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Migraine History May Predict Severity of Illness in Depressed Patients

MigraineOct 04, 05

A previous diagnosis of migraine suggests that a fresh diagnosis of Depression may mean a particularly severe illness, with significant comorbidities.

In a presentation to the American Academy of Family Physicians meeting here, a group from Kalamazoo, Mich., reported on an office-based chart review of 107 patients newly diagnosed with Depression.

Of them, 48.6% also had migraines, a high rate of depression and migraine that had been shown by previous work, reported Gary E. Ruoff, M.D., and colleagues.

Because only half of those with migraines were under a physician’s care for the headaches, the comorbidity was not obvious from looking at past medical records. “If we hadn’t asked about migraine we could have missed it,” said Dr. Ruoff.

In addition, when the depressed patients were separated into five categories of severity, using the PHQ9 scale, Dr. Ruoff and colleagues found that the risk of migraines increased with increasing severity of depression (p-value not given).

Of 262 comorbidities identified in the depressed patient group, such as anxiety, temporomandibular disorders, chronic pain, dysmenorrhea, 72.1% occurred in patients who had both depression and migraines versus only 28.9% in the depression-only group (no p-value given).

“Migraine becomes a marker for a more serious disease process,” concluded Dr. Ruoff. He noted that both migraines and depression are progressive disorders and hypothesized that early interventions might be particularly important in this patient group.

Barbara Yawn, MD., a family practitioner in private practice in Rochester, Minn., acknowledged that the results were interesting but expressed concern about patient selection in the study.

Because the researchers enrolled depressed patients and then asked about migraines, they might be identifying a “group of whiny patients,” she said. She suggested that if they screened all patients over a set period of time for both depression and migraines they might find a different relationship between the disorders.

Primary source: AAFP Presentation: The Association of Migraine and other comoribidities in a population of patients with depression.

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