A Bidirectional Relationship between Depression, Anxiety and Migraine Headache

Abstract

Depression is a significant contributor to the global burden of disease and affects people in all communities across the world. In 2010, migraine was ranked as the third most prevalent disorder and seven-highest specific cause of disability worldwide. Migraine diagnosis is based on the guidelines of the International Classification of Headache Disorders (ICHD-3) migraine has two major subtypes: migraine without aura is a clinical syndrome characterized by headache with specific features and associated symptoms. Migraine with aura is primary characterized by transient focal neurological symptoms that usually precede or sometimes accompany the headache. According to The impact of headache on an individual's functional health and well-being was screened and monitored by The Headache Impact Test (HIT). By using Structured Clinical Interview for DSM-IV "SCID I", the patients were diagnosed as Major Depressive Disorder, Persistent Depressive Disorder (Dysthymia) and/ or the following anxiety disorders: Panic Disorder, Agoraphobia, Social Phobia, Specific Phobia, Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Posttraumatic Stress Disorder (PTSD). We used Beck Depression Inventory (BDI) to asses depression severity and Hamilton Rating Scale for Anxiety (HAM-A) was used to evaluate the severity of Anxiety Numerous epidemiological and clinical research studies have confirmed elevated risk of mood and anxiety disorders in migraine as well as in chronic daily headache. Moreover, persons with migraine with or without major depression are at higher risk for suicide attempts than those without any history of migraine. Psychiatric comorbidity, especially depression and anxiety may decreased quality of life, poor prognosis, chronification of disease, poorer response to treatment, and increased medical costs. According to neurobiology of those disorders, Findings confirm the genetic association between migraine and anxious depression. There is evidence for involvement of both monoamine (serotonin and dopamine) and peptide (endorphin and encephalin) neurotransmitters in depression. Endorphins and encephalins are involved in both mood control and pain control. Functional neuroimaging studies revealed synaptic and structural plasticity alterations in different regions of the brain, including the frontal cortex and hippocampus in MDD patients. Stress is considered one of the greater contributors to chronification of migraine. Neurochemical changes which are induced by different physiological responses to stress may be involved. MDD is associated with a maladaptive response to stress, due to dysfunction of the hypothalamic-pituitary-adrenal axis (HPA axis). Abnormal hormone dynamics is a constant feature in mood disorders and can precede the onset of MDD. Stress hormonal alterations observed in MDD include impaired inhibition of cortisol release by dexamethasone, elevated cortisol values, increased excretion of cortisol and an overactive response to psychological stressors.