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Depression in headaches: chronification

Deligianni, Christina I.; Vikelis, Michail; Mitsikostas, Dimos D.

Current Opinion in Neurology: June 2012 - Volume 25 - Issue 3 - p 277–283
doi: 10.1097/WCO.0b013e328352c416
HEADACHE: Edited by Messoud Ashina

Purpose of review Recent evidence supports the suggestion that migraine is a chronic disorder with episodic attacks that increase in frequency in a subgroup of patients, transforming migraine into a refractory chronic condition with poor outcome and severe impact. Among the risk factors for migraine chronification depression figures notably. Early diagnosis and management of risk factors in migraineurs prevent migraine chronification and its consequences. The scope of this article is to review depression as a potential cofactor for migraine chronification.

Recent findings Population-based studies revealed that migraineurs often have symptoms of depression, with strongest associations for migraine with aura. Patients with depression also have an increased risk for migraine, migraine with aura in particular. Twin studies showed similar findings. This bidirectional relationship suggests that migraine and depression may share common causative factors, possibly genetically determined, that might control migraine chronification. Migraine patients may develop depression as a result of the demoralizing experience of recurrent and disabling headaches and depressed patients may develop migraine because of increased pain sensitivity, in the basis of a common genetic background.

Summary We suggest that clinicians consider depression as part of migraine management in order to optimize treatment and avoid migraine progression.

Neurology Department, Athens Naval Hospital, Athens, Greece

Correspondence to Dimos D. Mitsikostas, MD, PhD, 77A Vas. Sofias Avenue, Athens 11521, Greece. Tel: +30 2107254316; fax: +30 2107254317; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.