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The Journal of Headache and Pain

, Volume 13, Issue 8, pp 615–624

First Online: 25 September 2012Received: 20 June 2012Accepted: 10 August 2012


The aim of this study was to assess the role of depression as a predictor of new onset of chronic migraine CM among persons with episodic migraine EM. The American Migraine Prevalence and Prevention AMPP study followed 24,000 persons with severe headache identified in 2004. Using random-effects logistic regression, we modeled the probability that persons with EM in 2005 or 2006 would develop CM in the subsequent year. Depression was assessed in two ways, using a validated questionnaire PHQ-9 score ≥15 and based on self-reported medical diagnosis. Analyses were adjusted for multiple covariates including sociodemographics, body mass index, headache pain intensity, headache frequency, migraine symptom severity, cutaneous allodynia, acute medication overuse, anti-depressant use and anxiety. Of 6,657 participants with EM in 2005, 160 2.4 % developed CM in 2006. Of 6,852 participants with EM in 2006, 144 2.2 % developed CM in 2007. In fully adjusted models, PHQ-9 defined depression was a significant predictor of CM onset odds ratio OR = 1.65, 95 % CI 1.12–2.45. There was a depression-dose effect; relative to participants with no depression or mild depression, those with moderate OR = 1.77, 95 % CI 1.25–2.52, moderately severe OR = 2.35, 95 % CI 1.53–3.62, and severe depression OR = 2.53, 95 % CI 1.52–4.21 were at increased risk for the onset of CM. Among persons with EM, depression was associated with an increased risk of CM after adjusting for sociodemographic variables and headache characteristics. Depression preceded the onset of CM and risk increased with depression severity suggesting a potentially causal role though reverse causality cannot be excluded.

KeywordsDepression Chronic migraine Epidemiology Transformation Migraine Risk factors Dr. S. Ashina and Dr. D. Serrano are the joint first authors.

The members of the Enrico Greppi selection committee 2012 are: Luigi Alberto Pini, Dominique Valade, Paolo Martelletti, Paolo Calabresi, Messoud Ashina, and Cenk Ayata.

Electronic supplementary materialThe online version of this article doi:10.1007-s10194-012-0479-9 contains supplementary material, which is available to authorized users.

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