Anxiety and depression are reported to be frequently associated with migraine but how they impact on migraine-related disability, migraine subjects' quality of life, and medical and therapeutic management of migraine attacks has not been investigated. FRAMIG 3 is a nation-wide population-based postal survey carried out in France according to the 2004 international classification of headache disorders. Subjects who had had migraine attacks during the last 3 months (subjects with 'active migraine', N = 1957) were analysed for migraine-related disability (MIDAS score), quality of life (SF-12 questionnaire), and anxiety and depression (Hospital Anxiety and Depression Scale [HADS]) in comparison with non-migraine subjects (N = 8287). Survey results indicate that 50.6% of subjects with active migraine were anxious and/or depressive (28.0% had anxiety alone, 3.5% depression alone, and 19.1% both anxiety and depression; P < or = 0.01 versus non-migraine subjects for anxiety alone and combined anxiety and depression, NS for depression alone). Although, migraine-associated anxiety and depression do not appear to influence the drugs taken by migraine subjects for the acute treatment of migraine attacks, perceived treatment efficacy and satisfaction with treatment are lower in subjects with anxiety alone or combined with depression than in subjects with neither anxiety nor depression. Anxiety and depression should be systemically looked for and cared for in subjects consulting for migraine.

Migraine medical diagnosis and follow-up remain low in France. Careful medical consultation is a prime factor for migraine subject self-awareness of migraine, continued consultation, and use of recommended medications for the treatment of migraine attacks.

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