BERLIN – Patients with migraine and depression have more than twice the odds of experiencing cutaneous allodynia during a headache attack than do patients with migraine but no depression, according to a survey of 2,597 patients.
Current depression or history of depression was associated with 2.4 times greater odds of cutaneous allodynia (the perception of pain caused by non-noxious stimuli to normal skin), Dr. Mark Louter said at the International Headache Congress.
Allodynia also was clearly predicted by gender, age at onset of headaches, and increased frequency of migraine, Dr. Louter said.
Nearly 70%, or 1,810 of the 2,597 migraineurs who completed the digital depression questionnaire, reported cutaneous allodynia during their migraine attacks.
Women had significantly greater odds of reporting cutaneous allodynia, compared with men (odds ratio, 3.3).
Looked at another way, the odds for migraineurs who reported cutaneous allodynia to also report depression in their lifetime was significantly greater than for those who did not report allodynia (OR, 2.2). This multivariate logistic regression analysis was adjusted for age, gender, frequency of attack, type of migraine, and use of prophylactic medication.
A meeting attendee asked about depression severity. "That is a good question, but for this analysis, we dichotomized the patients into depression versus no depression," Dr. Louter responded.
"Cutaneous allodynia was associated with higher headache frequency, symptoms of anxiety and depression, and a younger onset of headache," said Dr. Louter, a physician-researcher in neurology and psychiatry at Leiden (Netherlands) University Medical Center.
The study was cross-sectional, so causality cannot be demonstrated, Dr. Louter said at the congress, which was sponsored by the International Headache Society and the American Headache Society. Respondents were adults with migraine aged 18-74 years who had been identified from the Leiden University Medical Centre Migraine Neuro-Analysis Program (LUMINA) database.
Migraine type and body mass index were not significantly associated with presence of cutaneous allodynia.
A total 3,029 self-reported migraineurs completed a headache questionnaire based on ICHD-II migraine criteria; 2,597 completed a depression questionnaire that included the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D), the Center for Epidemiologic Studies Depression (CES-D) scale, and additional questions about lifetime depression. Another 2,269 answered a follow-up questionnaire on headache frequency. Cutaneous allodynia was assessed with a validated 12-item scale, similar to the Allodynia Symptom Checklist.
This study demonstrates that two-thirds of migraineurs have cutaneous allodynia during their attacks, Dr. Louter said. Important findings include a preponderance of cutaneous allodynia among women with migraine, but most importantly, in migraineurs with lifetime depression, he added.
"We think more research is needed to evaluate this further," Dr. Louter said.
Dr. Louter said that he had no relevant disclosures.