While there is a clear association between major depressive disorder (MDD) and migraine, data published in Cephalgia provide evidence for divergent association of lifetime MDD, and MDD subtypes, with the prevalence and severity of symptoms in patients with migraine with and without aura.

It is well known that migraine and depression show a high rate of comorbidity and previous studies have suggested the association is bidirectional, with each disorder increasing the risk for onset of the other. However, limited data are available on the association between MDD subtypes and migraine.

The goal of this cross-sectional study was to assess the associations between atypical, melancholic, combined, and unspecified subtypes of MDD and migraine with and without aura. In addition, the researchers aimed to explore the associations between MDD and its subtypes with the severity of migraine.

The study included 446 patients with migraine (294 with migraine without and 152 with migraine with aura) from the population-based CoLaus/PsyCoLaus cohort study. Researchers only included patients with available information on the comorbidity of MDD. The control group was comprised of 2511 patients with MDD, or its subtypes, but no migraine.

Despite a significant association between lifetime MDD and migraine regardless of subtype, a stronger association was observed in migraine with vs without aura. Further, while all MDD subtypes were associated with migraine in general, all subtypes but atypical MDD were associated with migraine with aura; only melancholic MDD was significantly associated with increased frequency of migraine without aura.

As for the association between MDD and migraine intensity, the statistical analysis revealed a significant association between unspecified MDD subtype with higher migraine intensity only in patients with but not without aura.

Combined MDD, which included subjects with both melancholic and atypical characteristics, was found to be associated with higher migraine frequency, regardless of migraine subtype.

The researchers acknowledged that the study had several limitations, including its cross-sectional design, use of semi-structured interviews that can be associated with inaccurate recall of remote episodes, and a relatively small sample of patients with atypical or combined MDD.

Further studies exploring the pathophysiological mechanisms shared between melancholic depression and migraine are warranted, concluded the researchers.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors disclosures

Reference

Pisanu C, Lundin E, Preisig M, et al. Major depression subtypes are differentially associated with migraine subtype, prevalence and severity. [published online October 1, 2019]. Cephalgia. doi:10.1177/0333102419884935

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