Comorbid Depression Among Patients with Migraine in Low Resource Setting

Abstract

Background and objectives: Migraine is commonly associated with psychiatric comorbidities, especially in developed countries. Herein, we investigated the burden of comorbid depression and associated factors among patients with migraine (PWM) in low resource setting. Methods: This was a hospital-based cross-sectional study of PWM conducted at Federal Neuropsychiatric Hospital (FNPH) Maiduguri. Consenting participants with known migraine on follow up visits were consecutively recruited. Depressive symptoms were ascertained using the Beck’s Depression Inventory (BDI), while the impact of migraine was assessed using the Headache Impact Test-6 (HIT-6) questionnaire. Multivariate regression analysis was done to determine independent factors associated with depression among migraineurs. Results: The study constituted 165 PWM. Participants were predominantly females (72.1%) and the mean age of the participants was 29.6 ± 9.6, with age range of 17-55 years. About 46% of migraineurs had mild to no impact, while 37.6% of the participants had severe headache impact. Increased migraine impact was associated with: female gender (P<0.037), migraine with aura (P<0.001), chronic migraine (P<0.001), photophobia (P<0.001), and poor utilization of prophylactic drugs (P<0.014). Forty-five percent of the participants had varying degrees of depression among which the majority (43.4%) had mild, 19.6% moderate, 14.3% severe, and 1.79% had extreme comorbid depression. Factors associated with depression were: female gender, migraine with aura, chronic migraine, photophobia, utilization of migraine prophylactic drugs, and impactful migraine all with P≤0.001. We found a strong positive linear relationship between headache impact and depression (r=0.76, P<0.001). On multivariate analysis, males had 76.3% less likelihood of being depressed [95% confidence interval (CI) of (0.068-0.828)] compared with their female counterparts. Increasing migraine impact was also significantly (P<0.05) associated with depression. Those with no impact, mild impact, and substantial impact of migraine had 97.4%, 97.1%, and 88.4% less likelihood of being depressed compared to those with severe impact with 95% CI (0.004-0.159), (0.006-0.148)], and (0.029-0.463)] respectively. Conclusion: We found a high prevalence of comorbid depression among PWM in our environment with inadequate utilization of treatment contributing to both the burden of migraine and depression.