From the Journal: Associations Between Depression/Anxiety and Headache Frequency in Migraineurs: a Cross-Sectional Study

Does migraine frequency influence the intensity of emotional expression?

Migraine has long been associated with emotional disturbance and distress, and although anecdotally we know that people with migraine say their quality of life is impaired by the disease, it remains unknown whether the intensity of emotional expression is directly related to migraine frequency. In a new study to be published in Headache, researchers probed for patterns in depression and anxiety in people with migraine attacks, cross-referenced against attack frequency.

The study examined 588 outpatients in Taiwan who experience migraine, and collected data on the frequency of their migraine attacks, the presence or absence of aura accompanying those attacks, demographic and clinical data including sleep characteristics, and depression and anxiety symptoms as assessed by the Beck’s Depression Inventory (BDI) and Hospital Anxiety and Depression Subscales (HADS). Patient data including each associated symptom variable was then plotted, stratified by migraine attack frequency, and researchers examined the resulting graphs to see if they could identify any patterns.

Their findings indicated that depression, according to BDI scores, was highest in patients with chronic migraine, followed in descending order by patients with high frequency, medium frequency, low frequency migraine, and lastly with non-migraine control patients, who had the lowest scores on the scale measuring depression symptoms. Similar results were obtained for the study of anxiety symptoms related to migraine frequency, with patients whose migraine attacks were most frequent scoring the highest on the HADS assessment of anxiety symptoms, control patients without migraine scoring the lowest, corresponding to the least observable experienced anxiety, and migraine frequency correlating directly with experienced anxiety between the two extremes.

In a companion analysis, BDI and HADS scores were both found to independently relate to high-frequency episodic and chronic migraine and to poor sleep quality. The relationship between depression (BDI score) and migraine frequency was consistent both in patients with and without aura as a symptom of their migraine.

In conclusion, the study’s findings solidified the long-suspected relationship between anxiety and depression and migraine frequency. Not only are migraine attacks known to be frustrating, painful and stress-inducing for patients who experience them, there is now access to data that specifically links this taxing disease to mental health complications that may add additional weight to the already heavy burden of chronic migraine.


The American Headache Society is committed to keeping its members up to date on the most innovative and meaningful advancements in the realm of headache medicine. One of many initiatives to support that mission is our publication of Headache: The Journal of Head and Face Pain, published ten times per year and continually online, which highlights the latest findings in the realm of headache medicine research. Our “From the Journal” series offers a preview of some of the groundbreaking work detailed in Headache. Enjoy access to the full catalogue of content plus a print subscription included with an American Headache Society Membership. Click here to become a member today.


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