Impact of Depression and Anxiety on Migraine-Related Disability: Results from the Headache Assessment via Digital Platform in the United States (HeAD-US) Study
Adalmina Sarkar1, Elham Ghanbarian1, Babak Khorsand1, Kristina Fanning2, Alexandre Urani3, François Cadiou3, Richard Lipton4, Ali Ezzati1
1University of California, Irvine, 2Mist Research, Wilmington, NC, USA, 3APTAR LLC, USA, 4Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical center, Bronx, NY, USA
Objective:
To assess the relationship between anxiety and depressive symptoms on headache-related disability in individuals with migraine in a real-world study.
Background:
Though symptoms of anxiety and depression are common in migraine, their association with disability is poorly characterized in real world studies.
Design/Methods:
We used cross-sectional data from 6267 participants with migraine recruited using the Migraine Buddy app to create the Headache Assessment via Digital Platform in the United States (HeAD-US) registry. Migraine disability was assessed using the Migraine Disability Assessment Scale (MIDAS). Anxiety and depressive symptoms were evaluated using the 4-item Personal Health Questionnaire (PHQ-4). Participants were categorized into four subgroups: anxiety symptoms only, depressive symptoms only, both, or neither. Negative binomial regression was used to explore associations between subgroups and migraine disability.
Results:
Participants were 41.5±13 years old on average, 90.8% were women, and 84.6% were white. 37.4% had chronic migraine (CM) while 62.6% had episodic migraine (EM). 91.5% had MIDAS scores of 11 or greater (moderate and severe disability).18.7% had anxiety symptoms only, 6.1% had depressive symptoms only, 23.8% had both, and 51.4% had neither. Coexisting anxiety and depressive symptoms were more common in CM than in EM (30.3% vs 20.0%; p<0.001) as were depressive symptoms alone (8.0% vs 4.9%; p<0.001). Differences in anxiety symptoms alone were not significant. Anxiety symptoms alone and depressive symptoms alone were associated with 8.7% (rr=1.087) and 28.4% (rr=1.284) increase in MIDAS score, respectively (both p<0.001). Coexisting anxiety and depression were associated with a 32.5% increase (rr=1.325, p<0.001) in MIDAS score.
Conclusions:
Symptoms of anxiety and depression are more common in CM than EM and associated with greater migraine disability separately and jointly. This real-world study extends findings from population and clinic-based studies.
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