Mental disorders and the incidence of migraine headaches in a community sample: Results from the baltimore epidemiologic catchment area follow-up study

Background: Although clinical and community studies have demonstrated a cross-sectional relation between migraine headaches and affective disorders, the temporal relation between specific psychiatric disorders and migraine headaches has received little study. The authors investigated the predictive role that depression and other psychiatric disorders may have for migraine headaches. Method: Participants in the Baltimore, Md., cohort of the Epidemiologic Catchment Area Program were assessed in 1981 for psychopathologic features and were subsequently asked about their history of headaches. Between 1993 and 1996, participants identified incidences of migraine headaches by self-report in follow-up interviews. The risk for migraine headaches was calculated by the demographic variables and psychopathologic features identified in the 1981 assessment. The authors estimated the cross-sectional association between prevalent migraine and lifetime psychiatric diagnoses and used logistic regression models to examine the relation between antecedent psychiatric disorders and incident migraine headaches. Results: A total of 1343 participants were found in 1981 to be at risk for migraine headaches; a total of 118 incident cases of migraine headaches were reported in these individuals at follow-up. Female sex and younger age were noted as risk factors for the development of migraine headaches. Crosssectional associations with migraine headaches were found for major depression (odds ratio [OR] = 3.14, 95% confidence interval [CI] = 2.03 to 4.84) and panic disorder (OR = 5.09, 95% CI = 2.65 to 9.79), but not for alcohol and other substance abuse. Phobia was the only psychiatric disorder found by logistic regression models to be predictive of incident migraine headaches (OR = 1.70, 95% CI = 1.11 to 2.58); no association was found between antecedent affective disorders and incident mi-graine headaches. These results were unchanged by the inclusion of history of use of tricyelic antidepressants in the models. Conclusions: Although a cross-sectional relation was found between affective disorders and migraine headaches in this population, no association between antecedent affective disorders and subsequent migraine headaches was identified.