Depression comorbidity among those with headache disorders is long-established. A new study suggests that the problem may be greater than currently recognised, with over 90% of people not receiving physician treatment for their headaches also suffering from at least some severity of depression. Among those suffering from migraine, 10% had moderately severe or severe depression, rising to 25% among those experiencing chronic daily headache.
The pilot study, initiated by Eurolight* - a partnership activity within Lifting The Burden, supported by a grant of the EC Public Health Executive Agency and promoted by the Centre of Public Health Research, Luxembourg - utilised a self-administered questionnaire in a population based study of 731 headache sufferers in Luxembourg.
The questionnaire captured age, gender, headache type, frequency of headache and incorporated the PHQ9 scale to determine depression severity.
In total, 46% of subjects suffered migraine, 47% non-migrainous headache and 7% chronic daily headache. Of these, just 8% of those with non-migrainous headache had no depression, dropping to 3% in those with migraine and 0% in chronic daily headache sufferers. The same held true for overall depression scores, with the lowest scores seen in non-migrainous headache sufferers and highest in chronic daily headache subjects (see Table).
| Depression severity | Non-migrainous headache | Migraine headache | Chronic daily headache |
| None | 8% | 3% | 0% |
| Minimal | 46% | 27% | 10% |
| Mild | 29% | 41% | 36% |
| Moderate | 10% | 19% | 19% |
| Moderately severe | 5% | 8% | 23% |
| Severe | 2% | 2% | 12% |
From the logistical model, the odds ratio (95% CI) of the overall score for depression severity for the migraine group showed migraine sufferers were most likely to experience moderate depression, over other severities of depression, with an odds ratio of 4.4, compared to no depression. The ORs for moderately severe or severe depression were 3.7 and 2.4 respectively. While ORs could not be calculated in the chronic daily headache group, the risk of depressive disorder was higher in this group (10.1), compared to the migraine group (1.6).
It is not just the existence of headache that appears to be a factor in depression severity, however, the frequency of headache attacks also plays a major role. Higher severity of depression was seen in those with high headache frequency.
In short, conclude the authors: "Headache diagnosis seems to play a less important role in prediction of depression than the frequency of headache."
The data provides further support for Eurolight's over-arching objective to provide a justification that headache should be high among healthcare priorities in Europe.
Andrée C, Vaillant M, Sandor PS. Depression as comorbidity in different types of headache. What is the effect of headache frequency? Poster presented at the International Headache Society, Stockholm, June 2007.
*Eurolight was launched in May 2007 and is the first consortium of stakeholders to collect data on headache at EU level, bringing together relevant medical, scientific and lay organisations. Its purpose is to survey the impact o headache throughout Europe in order to inform policy makersconsortium Objectives include: studying the general population prevalence of headache disorders in Lithuania; surveying mostly patient populations in 10 representative European countries; gathering qualitative as well as quantitative data that describe impact, in a broad sense, of each headache disorder of public-health importance (migraine, tension-type headache and chronic daily headache); assessing personal suffering, consequences for work, education and family life, and the needs for better disease management; and producing systematic data to complement epidemiological evidence of the burden of headache in Europe.