PHILADELPHIA – The comorbidities of anxiety and depression may not portend poorer outcome in patients being treated for severe migraine.
In fact, compared with patients who did not have anxiety or depression, patients with those disorders actually experienced greater improvement in their headache-related disability scores in a study conducted over 16 months, said Elizabeth Seng, a doctoral student in the department of psychology at Ohio University, Athens.
The results seem to belie conventional clinical wisdom that patients with psychiatric comorbidities don't respond to headache therapy as well as others, Ms. Seng said at a poster session at the International Headache Congress.
But clinician perception, rather than clinical response, is probably the root of this belief, she said in an interview. “I don't think this speaks as much to the relationship between psychiatric comorbidity and migraine, as to our assumptions about how that relationship impacts migraine treatment. In this study, participants who had comorbid depression and anxiety actually changed more over treatment,” reaching the same end points as those without depression or anxiety.
She extracted her results from the unpublished Treatment of Severe Migraine trial, led by Kenneth Holroyd, Ph.D., also of Ohio University. The trial randomized 232 patients with severe migraine. Everyone received optimal acute therapy including an abortive medication. Patients were then assigned to one of four treatment arms: placebo, beta blocker, behavioral management plus placebo, or behavioral management plus beta blocker.
The trial consisted of a 4-month run-in period and 12 months of treatment. Behavioral management consisted of clinic visits, telephone calls, and homework. The homework focused on relaxation, migraine warning signs and effective medication use, stress management or thermal biofeedback, and establishing an individual migraine management plan.
The cohort was 79% women, with a mean age of 38 years. They had an average of five headaches a month.
At baseline, patients with either anxiety or depression had higher average scores on the Headache Disability Inventory (HDI) than did those without the disorders (56 vs. 41, respectively). They also had higher scores on the Migraine-Specific Quality of Life (MSQOL) Questionnaire (43 vs. 37).
After 1 year, both groups improved significantly and similarly on both scales, regardless of their randomization group. On the HDI, those with comorbidities decreased an average of 33 points, to a score of 23; those without comorbidities dropped an average of 21 points, to a score of 20, Ms. Seng reported at the congress, sponsored by the International Headache Society and the American Headache Society.
On the MSQOL, the group with comorbidities dropped an average of 22 points to a final score of 21. The group without comorbidities dropped an average of 15 points to 22.
Ms. Seng cautioned that the results are preliminar, and the trial exncluded patients with medication overuse headache.
The study was supported by the National Institutes of Health. Merck and GlaxoSmithKline provided the study medication. Ms. Seng had no disclosures to report.