Anxiety/Depression Don't Hinder Migraine Tx

PHILADELPHIA — The psychiatric comorbidities of anxiety and depression may not portend poorer outcome in patients being treated for severe migraine, according to an analysis of results from a randomized, controlled trial.

In fact, compared with patients who did not have anxiety or depression, patients with those disorders actually experienced greater improvement in their headache-related disability scores over a 16-month period, said Elizabeth Seng, a doctoral student in the department of psychology at Ohio University, Athens.

The results seem to belie conventional clinical wisdom, which suggests that patients with psychiatric comorbidities don't respond to headache therapy as well as others, Ms. Seng said at a poster session during the International Headache Congress. But clinician perception, rather than clinical response, is probably the root of this belief, she said in an interview.

“In this study, participants who had comorbid depression and anxiety actually changed more over treatment,” reaching the same end points as those without depression or anxiety, Ms. Seng said.

She extracted her results from the unpublished Treatment of Severe Migraine trial, led by Kenneth Holroyd, Ph.D., also of Ohio University. The trial randomized 232 patients with severe migraine. Everyone received optimal acute therapy. Patients were then assigned to one of four treatment arms: placebo, beta-blocker, behavioral management plus placebo, or behavioral management plus beta-blocker.

The trial consisted of a 4-month run-in period and 12 months of treatment. Behavioral management consisted of clinic visits, telephone calls, and homework. The homework focused on relaxation, migraine warning signs, effective medication use, stress management or thermal biofeedback, and establishing an individual migraine management plan.

The cohort was 79% women, with a mean age of 38 years. They had an average of five headaches a month, with a 15-year headache history.

At baseline, patients with either anxiety or depression showed worse average scores on the Headache Disability Inventory (HDI) than did patients without those disorders (56 vs. 41, respectively). They also showed worse scores on the Migraine-Specific Quality of Life (MSQOL) Questionnaire (43 vs. 37).

After 1 year of treatment, both groups improved significantly and similarly on both scales. On the HDI, those with comorbidities decreased an average of 33 points, to a score of 23; those without comorbidities dropped an average of 21 points, to a score of 20, Ms. Seng reported at the congress, which was sponsored by the International Headache Society and the American Headache Society.

On the MSQOL, the group with comorbidities dropped an average of 22 points to a final score of 21. The group without comorbidities dropped an average of 15 points to a final score of 22.

The study was supported by the National Institutes of Health. Merck and GlaxoSmithKline provided the study medication. Ms. Seng had no relevant disclosures to report.

'In this study, participants who had comorbid depression and anxiety actually changed more over treatment.'

Source MS. SENG

PHILADELPHIA — The psychiatric comorbidities of anxiety and depression may not portend poorer outcome in patients being treated for severe migraine, according to an analysis of results from a randomized, controlled trial.

In fact, compared with patients who did not have anxiety or depression, patients with those disorders actually experienced greater improvement in their headache-related disability scores over a 16-month period, said Elizabeth Seng, a doctoral student in the department of psychology at Ohio University, Athens.

The results seem to belie conventional clinical wisdom, which suggests that patients with psychiatric comorbidities don't respond to headache therapy as well as others, Ms. Seng said at a poster session during the International Headache Congress. But clinician perception, rather than clinical response, is probably the root of this belief, she said in an interview.

“In this study, participants who had comorbid depression and anxiety actually changed more over treatment,” reaching the same end points as those without depression or anxiety, Ms. Seng said.

She extracted her results from the unpublished Treatment of Severe Migraine trial, led by Kenneth Holroyd, Ph.D., also of Ohio University. The trial randomized 232 patients with severe migraine. Everyone received optimal acute therapy. Patients were then assigned to one of four treatment arms: placebo, beta-blocker, behavioral management plus placebo, or behavioral management plus beta-blocker.

The trial consisted of a 4-month run-in period and 12 months of treatment. Behavioral management consisted of clinic visits, telephone calls, and homework. The homework focused on relaxation, migraine warning signs, effective medication use, stress management or thermal biofeedback, and establishing an individual migraine management plan.

The cohort was 79% women, with a mean age of 38 years. They had an average of five headaches a month, with a 15-year headache history.

At baseline, patients with either anxiety or depression showed worse average scores on the Headache Disability Inventory (HDI) than did patients without those disorders (56 vs. 41, respectively). They also showed worse scores on the Migraine-Specific Quality of Life (MSQOL) Questionnaire (43 vs. 37).

After 1 year of treatment, both groups improved significantly and similarly on both scales. On the HDI, those with comorbidities decreased an average of 33 points, to a score of 23; those without comorbidities dropped an average of 21 points, to a score of 20, Ms. Seng reported at the congress, which was sponsored by the International Headache Society and the American Headache Society.

On the MSQOL, the group with comorbidities dropped an average of 22 points to a final score of 21. The group without comorbidities dropped an average of 15 points to a final score of 22.

The study was supported by the National Institutes of Health. Merck and GlaxoSmithKline provided the study medication. Ms. Seng had no relevant disclosures to report.

'In this study, participants who had comorbid depression and anxiety actually changed more over treatment.'

Source MS. SENG

PHILADELPHIA — The psychiatric comorbidities of anxiety and depression may not portend poorer outcome in patients being treated for severe migraine, according to an analysis of results from a randomized, controlled trial.

In fact, compared with patients who did not have anxiety or depression, patients with those disorders actually experienced greater improvement in their headache-related disability scores over a 16-month period, said Elizabeth Seng, a doctoral student in the department of psychology at Ohio University, Athens.

The results seem to belie conventional clinical wisdom, which suggests that patients with psychiatric comorbidities don't respond to headache therapy as well as others, Ms. Seng said at a poster session during the International Headache Congress. But clinician perception, rather than clinical response, is probably the root of this belief, she said in an interview.

“In this study, participants who had comorbid depression and anxiety actually changed more over treatment,” reaching the same end points as those without depression or anxiety, Ms. Seng said.

She extracted her results from the unpublished Treatment of Severe Migraine trial, led by Kenneth Holroyd, Ph.D., also of Ohio University. The trial randomized 232 patients with severe migraine. Everyone received optimal acute therapy. Patients were then assigned to one of four treatment arms: placebo, beta-blocker, behavioral management plus placebo, or behavioral management plus beta-blocker.

The trial consisted of a 4-month run-in period and 12 months of treatment. Behavioral management consisted of clinic visits, telephone calls, and homework. The homework focused on relaxation, migraine warning signs, effective medication use, stress management or thermal biofeedback, and establishing an individual migraine management plan.

The cohort was 79% women, with a mean age of 38 years. They had an average of five headaches a month, with a 15-year headache history.

At baseline, patients with either anxiety or depression showed worse average scores on the Headache Disability Inventory (HDI) than did patients without those disorders (56 vs. 41, respectively). They also showed worse scores on the Migraine-Specific Quality of Life (MSQOL) Questionnaire (43 vs. 37).

After 1 year of treatment, both groups improved significantly and similarly on both scales. On the HDI, those with comorbidities decreased an average of 33 points, to a score of 23; those without comorbidities dropped an average of 21 points, to a score of 20, Ms. Seng reported at the congress, which was sponsored by the International Headache Society and the American Headache Society.

On the MSQOL, the group with comorbidities dropped an average of 22 points to a final score of 21. The group without comorbidities dropped an average of 15 points to a final score of 22.

The study was supported by the National Institutes of Health. Merck and GlaxoSmithKline provided the study medication. Ms. Seng had no relevant disclosures to report.

'In this study, participants who had comorbid depression and anxiety actually changed more over treatment.'

Source MS. SENG