Neurology & Stroke

A migraine is a primary headache disorder that is associated with more years of disability than any other neurological condition.1 Episodic migraine (attacks on less than 15 days a month) and chronic migraine (headache on 15 or more days a month over more than 3 months) are distinguished.2 The progression from episodic migraine to chronic migraine (a process called transformation) occurs in approximately 2% of patients with episodic migraine each year.3 Epidemiological studies have identified a number of modifiable and non-modifiable risk factors for the progression to chronic migraine.4 Modifiable risk factors include depression, anxiety, stressful events, obesity, sleep disorders, snoring, excessive consumption of caffeine, excessive consumption of analgesics, and cutaneous allodynia.5,6 The state-of-the-art prevention and treatment programmes for chronic migraine are primarily directed to target modifiable risk factors, because chronic migraine is characterized by worse maladaptation, low quality of life, higher need for medical assistance, and greater occurrence of comorbid somatic and psychiatric diseases, including depression, as compared with episodic migraine.5,7-9 Depression is a psychiatric disease; its main characteristic is low mood. A diagnosis of a depressive episode (ICD-10) requires the presence of two major symptoms and at least three minor symptoms (Table 1).10

Other forms of depression observed in neurological practice include recurrent depression (recurrent depressive episodes) and dysthymia (persistent depressive disorder). These forms develop largely as a result of inadequate therapy, i. e. administration of drugs with different mechanisms of action (such as tranquilizers or neurometabolic agents) for the treatment of depression, insufficient duration of antidepressant therapy (less than 6 months), and insufficient therapeutic doses of antidepressant drugs.11

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Epidemiological studies have demonstrated that the lifetime likelihood of depression in the general population is in the range of 5% to 17%.12 Migraine and depression are highly comorbid and interrelated pathophysiologically.13 Depression increases the risk of migraine 4.5 times.13 A recent study reported by Ashina S et al.,14 that included data collected in over 6,000 patients demonstrated that a depressive episode was the most significant predictor of the transformation of episodic migraine into the chronic form over the next year. The more severe the depression the higher the relative risk of transformation: it was found to be 1.8 in mild depression, 2.4 in moderate depression, and 2.5 in severe depression. Another population-based study showed that depression was the main factor, even regardless of socio-economic factors, number of days of headache per month, amount of analgesic medication, and other comorbidities. It should be underlined that antidepressant therapy, i. e. adequate treatment of depression, does not increase the risk of migraine.15

The objective of this study was to evaluate the long-term effect of depression on the course of migraine, as well as the efficacy and safety of antidepressant therapy in patients with depression associated with migraine and the effects of this therapy on the prognosis of migraine.

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