Associations Between Depression/Anxiety and Headache Frequency in Migraineurs: A Cross-Sectional Study

Background.-While migraines have been associated with emotional disturbances, it remains unknown whether the intensity of emotional expression is directly related to migraine frequency. Objective.-The present study investigated depression/anxiety among migraineurs. Methods.-This cross-sectional study included 588 clinical outpatients in Taiwan. Migraines were stratified by attack frequency, with and without auras, and with well-controlled confounding variables. Demographic and clinical data, including sleep characteristics, were collected. Multivariable linear regressions were employed to examine whether migraine frequency (1-4 headache days per month, 5-8 headache days per month, 9-14 headache days per month, or > 14 headache days per month) was associated with depression/anxiety symptoms, as indicated by the Beck's Depression Inventory (BDI) and Hospital Anxiety and Depression Subscales (HADS). Results.-BDI total scores were highest in patients with chronic migraines (mean +/- SD: 13.2 +/- 8.5), followed by those with high frequency (12.1 +/- 8.5), medium frequency (10.6 +/- 8.0), low frequency (9.1 +/- 7.1), and lowest in nonmigraine controls (6.6 +/- 5.9), with a significant trend in frequency (P trend<.001); similar results were obtained for HADS scores. BDI and HADS scores were independently related to high-frequency episodic and chronic migraine frequency and to poor sleep quality. The relationship between BDI score and migraine frequency was present in both aura-present (P trend = .001) and aura-absent subgroups (P trend = .029). Conclusion.-Higher migraine frequency, either with or without auras, correlated with higher symptom scores of anxiety and depression.