Migraine tied to increased anxiety and depression among children and adolescents: JAMA

Canada: A recent original investigation published in JAMA Paediatrics concluded that there is an increased risk of anxiety and depressive symptoms in children and adolescents with migraine. The study highlighted the benefits of routine screening of such patients in clinical practice.

A previous study published in the Journal of Headache and Pain, BMC, concluded that Anxiety is more robustly associated with an increased risk of migraine than depression. The main reason behind this is a lack of control over worrying and relaxation. A symptom-based approach is helpful in migraine comorbidity clarification and should be replicated in other studies.

The question is, what is the magnitude of association between anxiety and depressive symptoms in children and adolescents with migraine if any? There is a presumption that children and adolescents with a history of migraine face internalizing symptoms and disorders, but there is a lack of high-level summative evidence to support this fact.

Considering this, a study was conducted by a team of researchers led by Mario Fernando Prieto Peres from the Albert Einstein Hospital, Institute of Psychiatry at the University of São Paulo, Brazil, to answer the above question. The study was a systematic review and meta-analysis of 80 observational studies.

The critical points of the study are:

• The primary outcome was diagnosis of migraine.
• The database searched was MEDLINE, Embase, PsycINFO, and CINAHL databases.
• Studies were described qualitatively on the unavailability of sufficient pooling data.
• Migraine outcomes, incidence, and associations between outcomes and internalizing symptoms and disorders were also included in the evaluation.
• Four thousand nine hundred forty-six studies were screened, and 80 were included in the review.
• The association between internalizing symptoms, disorders, and migraine was reported in 74 studies.
• Fifty-one studies were amenable to pooling.

Meta-analyses comparing children and adolescents with migraine and with healthy controls showed evaluated the following results:

• An association between migraine and anxiety symptoms had SMD of 1.13;
• An association between migraine and depressive symptoms had an SMD of 0.67.
• The odds of anxiety disorders were significantly higher, with an OR of 1.93.
• The odds of depressive disorders was OR, 2.01 (with vs. without migraine).
• Stratification of results revealed no difference between clinical vs. community/population-based samples.
• There was no reported evidence of publication bias.
• Twenty studies assessed the association between internalizing symptoms or disorders and migraine outcomes (n = 18) or incident migraine (n = 2)and were summarized.

Dr. Juliane P. P. Mercante wrote that we found a significant association between anxiety and depressive symptoms and disorders in children and adolescents with migraine compared to healthy controls. Our study focussed on the benefits of routinely screening such patients in clinical practice. However, there is an unclarity of whether anxiety and depression affect migraine incidence and outcomes.

Further reading:

Falla K, Kuziek J, Mahnaz SR, Noel M, Ronksley PE, Orr SL. Anxiety and Depressive Symptoms and Disorders in Children and Adolescents With Migraine: A Systematic Review and Meta-analysis. JAMA Pediatr. Published online October 31, 2022. doi:10.1001/jamapediatrics.2022.3940