Brief report
Depressive symptoms and migraine comorbidity among pregnant Peruvian women

https://doi.org/10.1016/j.jad.2009.07.014Get rights and content

Abstract

Background:

Migraine and depression are known to be comorbid conditions in non-pregnant women and men. However, the migraine–depression comorbidity among pregnant women, particularly women in developing countries has not been evaluated. Therefore, we evaluated the migraine-depressive symptom relationship in a large cohort of pregnant Peruvian women.

Methods:

Women who delivered singleton infants (n = 2293) at the Instituto Nacional Materno Perinatal, Lima, Peru were interviewed during the postpartum hospital stay. Women were asked questions related to their lifetime and pregnancy experiences with headaches and migraines. Responses to these questions enabled the classification of “probable” and “strict” migraines according to the International Headache Society diagnostic criteria. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire Depression Subset. Logistic regression procedures were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs).

Results:

Approximately 32% of the women reported a history of migraine, while 41% reported experiencing moderate to severe depressive symptoms during pregnancy. Compared with women without a history of migraine, women with strict migraine had AORs of 2.12 (95% CI 1.54–2.93), 1.85 (95% CI 1.16–2.96) and 2.23 (95% CI 1.08–4.62) for moderate, moderately severe and severe depressive symptoms, respectively.

Conclusion:

This is the first report of a cross-sectional association between migraine and depressive symptoms in pregnant women. If our findings are confirmed, pregnant women with a history of migraine may benefit from increased vigilance for screening and treating depressive symptoms.

Introduction

Migraine, a recurrent primary headache disorder, is characterized by episodes of severe throbbing, pulsatile headache associated with nausea, vomiting, photophobia, phonophobia, and aversion to physical activity (Menon and Bushnell, 2008). Migraines are particularly common among women of childbearing age (Lipton et al., 2007). Age-specific prevalence of migraine in women of childbearing age has been reported to range between 5% and 45% (Lipton et al., 2007, Morillo et al., 2005). Reviews of migraine during pregnancy have found that preexisting migraine may diminish or disappear in majority of pregnant women, or remain unchanged, worsen or appear for the first time during pregnancy (Adeney and Williams, 2006, Menon and Bushnell, 2008). Moreover, several investigators have reported associations between a history of migraine and an increased risk of preeclampsia (Adeney and Williams, 2006, Sanchez et al., 2008) and stroke during pregnancy (James et al., 2005, Kittner et al., 1996).

Perinatal depression encompasses major and minor depressive episodes that occur either during pregnancy or within 1 year postpartum (Bennett et al., 2004). Meta-analyses of perinatal depression reported point prevalence estimates between 6% and 13% (Gavin et al., 2005). Perinatal depression is of concern because it has been linked to negative health-related behaviors and outcomes, including poor nutrition, increased use of alcohol, tobacco and illicit drugs, inadequate prenatal care, impaired fetal growth, preeclampsia, preterm delivery, postpartum postnatal depression, and suicide (Barrio and Burt, 2000, Hoffman and Hatch, 2000, Horrigan et al., 2000, Kurki et al., 2000, Llewellyn et al., 1997, Najman et al., 2000).

Clinic and community-based studies have documented associations between depression and migraine (Breslau et al., 1994, Breslau et al., 2003, Breslau et al., 2000, Jette et al., 2008, Kalaydjian and Merikangas, 2008, Merikangas et al., 1990, Swartz et al., 2000, Zwart et al., 2003). Some of these studies have demonstrated bi-directional relationships between migraine and depression, with each disorder increasing the relative risk for the subsequent first onset of the other (Breslau et al., 1994, Breslau et al., 2003, Breslau et al., 2000, Swartz et al., 2000). To our knowledge, there is no published study on the association between migraine and depression in pregnant women.

Both migraine and depression are prevalent among women in Lima, Peru (Adeney et al., 2006, Peru, 2002). A survey conducted in the metropolitan areas of Lima and Callao documented a high prevalence of lifetime depressive disorders (23%) (Peru, 2002). Additionally, lifetime prevalence of migraine among reproductive age women in Lima were reported to be 29% (Adeney et al., 2006) and 17% (Sanchez et al., 2008). The high prevalence of migraine and depressive disorders, together with the potential for co-occurrence of these disorders are a concern because a diagnosis of one should lead to increased vigilance for screening and treating the other. There are no published reports on the co-occurrence of migraine and depressive symptoms in pregnant women. We, therefore, examined the relationship between migraine and depressive symptoms in a large cohort of pregnant Peruvian women who participated in a postpartum interview study.

Section snippets

Subjects

Participants were 2394 women who delivered at the Instituto Nacional Materno Perinatal (INMP) in Lima between August, 2005 and June, 2006. Study subjects were recruited within 4 days of delivery, and the participation rate was 99%. Written consent was obtained from all participants. Of the 2394 participants, women who delivered twins (n = 31), had infants with gross malformation (n = 43), and with missing information on key variables such as migraine status or depressive symptoms (n = 27) were

Results

The majority of the women were between 20 and 29 years of age, unmarried, had low levels of education, and limited access to basic foods and medical care. Approximately 32% of the sample reported a history of migraine while 41% of the sample reported moderate to severe depressive symptoms (PHQ-9 score  10) during pregnancy (Table 1). Our results indicate that 55.1% of women with strict migraine and 48.0% of women with probable migraine experienced moderate to severe depressive symptoms major or

Discussion

Women with a history of migraine had statistically significantly higher odds of moderate to severe depressive symptoms when compared with women without migraine. To the best of our knowledge, this is the first study examining the relationship between migraine and depressive symptoms in pregnant women. Although there are no published findings for this relationship specific to pregnant woman, our findings are consistent with the following cross-sectional studies reporting associations between

Role of funding source

This research was supported by awards from the National Institutes of Health (NIH), Center for Minority Health and Health Disparities (T37-MD001449) and the Eunice Shriver Kennedy, National Institute of Child Health and Human Development (5R01 HD055566). The NIH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgements

We thank the women for their participation in this study.

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