In this issue of the Scandinavian Journal of Pain, Tomé-Pires and coworkers investigate the relative importance of anxiety and depression in people with migraine headache . Through a cross-sectional study of 43 university students with self-reported migraine, they look at associations between pain impact and anxiety and depression. ‘Pain impact’ refers to the consequences that the pain has on different life domains, such as social and cognitive functioning and vitality, and is thus a measure of everyday function . Their findings imply that anxiety is more important for pain impact than depression. The association between anxiety and pain impact was strong and salient, even after they controlled for other pain variables, while the association between depression and pain impact was weak and not statistically significant.1High psychiatric comorbidityMigraine affects around 11% of the population worldwide and causes substantial levels of disability for those affected . Psychiatric comorbidity in migraine sufferers is high, particularly when it comes to anxiety disorders which are two to five times more prevalent in patients with migraine than in the general population . Psychological factors, such as stress-related life events and depression, are also crucial risk factors for conversion from episodic to chronic migraine . Emotional distress has to some extent been associated with levels of disability and pain impact , but the relative importance of anxiety and depression is not clear. The current study therefore offers some new insights by demonstrating a stronger association between anxiety and pain impact than between depression and pain impact in a sample of individuals with migraine.2Important implications if replicatedThe study has some limitations that the authors themselves fully acknowledge. First and foremost, the study population is small and based on a convenience sample of university students. Forty of the forty-three participants were female, making it impossible to investigate any gender effects or to generalize the findings to male sufferers of migraine headache. The findings would thus have to be replicated with a larger and more representative sample. Nevertheless, if the findings are replicated, they clearly would and should have clinical implications. If anxiety is indeed a significant trigger of migraine attacks, as well as involved in exacerbation of disability, targeting anxiety in migraine treatments could be one way to improve the lives of people suffering from this highly prevalent and disabling neurological disorder.In conclusion, the paper offers new insights about the relative importance of anxiety and depression in migraine, but needs to be replicated in large-scale studies with representative samples. Nevertheless, if the findings do hold true, they clearly should result in clinical implications such as targeting anxiety directly in migraine treatments.Conflict of interest: None declared.ReferencesTomé-Pires C, Solé E, Racine M, Galán S, Castarlenas E, Jenen M, Miró J. The relative importance of anxiety and depression in pain impact in individuals with migraine headaches. Scand J Pain 2016;13:109–13.28850506http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000391261500016&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Tomé-PiresCSoléERacineMGalánSCastarlenasEJenenMMiróJThe relative importance of anxiety and depression in pain impact in individuals with migraine headachesScand J Pain20161310913Kosinski M, Bayliss MS, Bjorner JB, Ware Jr JE, Garber WH, Batenhorst A, Cady R, Dahlof CG, Dowson A, Tepper S. A six-item short-form survey for measuring headache impact: the HIT-6. 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Migraine and its psychiatric comorbidities. J Neurol Neurosurg Psychiatry 2016;87:741–9.2673360010.1136/jnnp-2015-312233http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000380391900010&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3MinenMTBegasse De DhaemOKroon Van DiestAPowersSSchwedtTJLiptonRSilbersweigD.Migraine and its psychiatric comorbiditiesJ Neurol Neurosurg Psychiatry2016877419May A, Schulte LH. Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol 2016;12:455–64.2738909210.1038/nrneurol.2016.93http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000381717800005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3MayASchulteLH.Chronic migraine: risk factors, mechanisms and treatmentNat Rev Neurol20161245564Magnusson JE, Becker WJ. 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Scandinavian Journal of Pain – de Gruyter
Published: Oct 1, 2016
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