Migraine Intensity Affects Muscle Pain in Major Depressive Disorder

Migraine and headache intensity play a key role in muscle soreness or pain (MS/P) in patients with major depressive disorder (MDD), according to research published in The Journal of Headache and Pain.¹ Researchers believe that central sensitization from chronic migraine may put patients with MDD at risk for hypersensitivity to other pain stimuli.

Previous research has established correlations between depression, migraine, headache, and fibromyalgia, of which musculoskeletal pain is a major characteristic.^2-6 However, it is not clear what impact headache frequency and intensity has on pain symptoms of MDD.

In the current study, researchers led by Ching-I Hung, MD, of Chang Gung Memorial Hospital in Taipei, Taiwan recruited 155 participants (mean age 30.3 ± 8.0 years; 68.4% female) who met DSM-IV criteria for MDD, and who were currently experiencing a major depressive episode.

At baseline, patients had not taken any antidepressants or other psychotropic drugs in the previous 4 weeks. Migraine diagnosis (with or without aura) was established via a patient-provided headache intake form and headache specialist evaluation. Headache intensity was measured using a visual analog scale (0-10) and headache frequency was based on number of headaches in the previous week.

Anxiety disorders were diagnosed via a structured clinical interview with a psychiatrist and severity of depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale (HADS). Average muscle soreness or pain was evaluated with a visual analog scale (0-10), and was evaluated in 5 domains — neck, shoulder, back, and upper and lower limbs — and was measured with a visual analog scale (0-10). Headache intensity and frequency, the HADS, and muscle soreness or pain were evaluated at baseline and at 2-year follow-up.

At baseline, 47.1% of participants were diagnosed with migraine, and 45.2% had anxiety disorders. Notably, participants with migraine were more likely to have an anxiety disorder than those without migraine. Average headache intensity was 4.2 out of 10 at baseline, and average headache frequency was 3.4 headache days in the previous week. Following enrollment, participants were treated for 4 weeks with 75mg per day of extended-release venlafaxine and zolpidem. After 4 weeks, patients were treated as general psychiatric outpatients with no pharmacotherapy management. Ultimately, 131 participants were included in the 2-year follow-up.

At follow-up, 30 patients were currently receiving pharmacotherapy, of which 18 were treated with venlafaxine and 12 with other antidepressants. 19 participants were treated with benzodiazepine or other hypnotics. Migraine was more strongly associated with muscle soreness or pain in all domains at baseline and in upper and lower limbs at follow-up compared with anxiety disorders. After controlling for depression and anxiety, headache intensity was most significantly associated with muscle soreness or pain in all domains at both baseline and follow-up, and also predicted muscle soreness or pain and baseline and follow-up.

Overall, migraine was more strongly associated with muscle soreness or pain in most domains than anxiety disorders, leading the authors to conclude that “clinicians should not ignore migraine when treating MS/P in patients with MDD.”

“Migraine and headache intensity should not be neglected in the treatment of MS/P in patients with MDD,” they continued. “Simultaneously, treatment of depression and headache might improve MS/P.”