Migraine is independently associated with poorer health-related quality of life (HRQoL) in the pain dimension and more severe pain symptoms in patients with major depressive disorder (MDD), researchers found.

Because simultaneous treatment might help improve pain symptoms and the score in the pain dimension of the HRQoL, they recommended that migraine prevention be integrated into the treatment of depression.

Their study appears in The Journal of Headache and Pain.

The researchers investigated the associations of migraine with pain symptoms over ten years in 290 outpatients with MDD, with follow-up at six-month, two-year, and ten-year time points. They diagnosed MDD and anxiety comorbidities with the Structured Clinical Interview for DSM-IV-text revision and migraine with the International Classification of Headache Disorders. They also used the bodily pain subscale of the Short Form 36 (SF-BP) and the pain subscale (PS) of the Depression and Somatic Symptoms scale.

SF-BP scores were lower, and PS scores were higher in patients with MDD who had migraines than those who did not. Depression, anxiety, and headache indices were significantly correlated with SF-BP and PS scores. The higher the migraine frequency, the more often patients had pain symptoms.

The researchers drew a number of conclusions:

• Migraine is an important comorbidity associated with greater severity of pain symptoms during long-term follow-up.

• Patients with migraine also have greater severities of depression and anxiety.

• Migraine, an important factor associated with pain symptoms, was found to be independent of the effects of depression and anxiety.

• Pharmacotherapy for MDD that focuses on depression and anxiety only and neglects the role of migraine in pain symptoms might not fully resolve pain symptoms and could lead to residual symptoms — a possible reason why pain symptoms often become residual symptoms.

• Depression and migraine should be treated simultaneously.

• Migraine prevention is essential because migraine is associated not only with pain but also with cardiovascular diseases, cerebrovascular diseases, and fibromyalgia.

• Improving pain symptoms might decrease depressive symptoms in patients with depression.

• Patients with MDD who use NSAIDs for headaches should be monitored for medication overuse because depression and anxiety are associated with a higher risk of medication-overuse headaches.

• Some therapeutic strategies for depression — antidepressants (e.g., serotonin-norepinephrine reuptake inhibitors and amitriptyline), cognitive behavioral therapy, and relaxation techniques — also treat migraine.

• Cognitive behavioral therapy might improve patients’ self-management of diseases and promote adaptive behaviors and skills for coping with stress.

• For the simultaneous treatment of depression and migraine, healthcare professionals might use multimodal therapeutic strategies based on patient preference, disease severity, possible adverse effects, and prior adherence history.