Migraine features in migraineurs with and without anxiety–depression symptoms: A hospital-based study

•We evaluated a consistent group of migraineurs measuring systematically many clinical variables (including psychiatric features).•Our results are in line with recent speculative hypothesis considering migraine a dysfunction of a “neurolimbic” pain network.•Particular migraine phenotypes could lead to identify subgroups of migraine patients.

BackgroundMigraine, anxiety and depression often coexist. A “neurolimbic” model of migraine has been recently proposed accounting for a dynamic influence of pain, mood and anxiety on the migraine disease. However, very few data exist concerning clinical migraine features in patients reporting anxiety–depression symptoms.ObjectiveAim of our study was to test differences in clinical migraine features between migraineurs with anxiety–depression symptoms and migraineurs without ones.Materials and methodsWe recruited 200 consecutive migraineurs. Other primary headaches comorbidity and migraine prophylaxis were exclusion criteria. Each patient was interviewed following a structured questionnaire including general features about migraine, triggers, allodynia. Anxiety and depression symptoms were evaluated in each patient by two brief self-reported scales: the generalized anxiety disorder 7-item scale (GAD-7) and the Patient Health Questionnaire 9-item scale (PHQ-9). A cut-off of 5 in both the GAD-7 and the PHQ-9 was considered positive for the presence of anxiety–depressive symptoms.ResultsOne hundred and one patients (51.5%) had anxiety–depression symptoms (GAD-7 and PHQ-9 ≥ 5). They reported a more headaches/month (p = 0.004), higher number of triggers (p < 0.001), and were more allodynic (p = 0.005). In a binary logistic regression model triggers and allodynia made a unique statistical contribution on reporting anxiety–depression symptoms.ConclusionOur results showed that the presence of anxiety–depression symptoms affects migraine clinical presentation. They are associated with enhanced migraine triggers susceptibility, more ictal allodynic symptoms as well as more headaches/month. An altered sensation in migraineurs with anxiety–depression symptoms could be a result of a lower pain threshold and an increased cortical excitability in a broader context of a neurolimbic dysfunction.