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Multicenter Study
. 2020 May 29;21(1):58.
doi: 10.1186/s10194-020-01120-7.

The impact of remission and coexisting migraine on anxiety and depression in cluster headache

Byung-Su Kim  1 , Pil-Wook Chung  2 , Byung-Kun Kim  3 , Mi Ji Lee  4 , Jeong Wook Park  5 , Min Kyung Chu  6 , Jin-Young Ahn  7 , Dae Woong Bae  8 , Tae-Jin Song  9 , Jong-Hee Sohn  10 , Kyungmi Oh  11 , Daeyoung Kim  12 , Jae-Moon Kim  12 , Soo-Kyoung Kim  13 , Yun-Ju Choi  14 , Jae Myun Chung  15 , Heui-Soo Moon  2 , Chin-Sang Chung  4 , Kwang-Yeol Park  16 , Soo-Jin Cho  17
Affiliations
Multicenter Study

The impact of remission and coexisting migraine on anxiety and depression in cluster headache

Byung-Su Kim et al. J Headache Pain. .

Abstract

Background: Our aim was to investigate the relationship between coexisting cluster headache (CH) and migraine with anxiety and depression during active cluster bouts, and how symptoms change during remission.

Methods: We analyzed data from 222 consecutive CH patients and 99 age- and sex-matched controls using a prospective multicenter registry. Anxiety or depression was evaluated using the Generalized Anxiety Disorder-7 (GAD-7) or Patient Health Questionnaire-9 (PHQ-9), respectively. Moderate-to-severe anxiety or depression was defined as a score of ≥10 at baseline (during a cluster bout). We assessed for changes in anxiety and depression during CH remission periods.

Results: Among the CH patients, the prevalence of moderate-to-severe anxiety and depression was seen in 38.2% and 34.6%, respectively. Compared with controls, CH patients were associated with moderate-to-severe anxiety and depression (multivariable-adjusted odds ratio [aOR] = 7.32, 95% confidence intervals [CI] = 3.35-15.99 and aOR = 4.95, 95% CI = 2.32-10.57, respectively). CH patients with migraine were significantly more likely to have moderate-to-severe anxiety and depression (aOR = 32.53, 95% CI = 6.63-159.64 and aOR = 16.88, 95% CI = 4.16-68.38, respectively), compared to controls without migraine. The GAD-7 and PHQ-9 scores were significantly reduced between cluster bout and remission periods (from 6.8 ± 5.6 to 1.6 ± 2.8; P < 0.001, and from 6.1 ± 5.0 to 1.8 ± 2.4; P < 0.001, respectively).

Conclusions: Our results indicate that CH patients are at increased risk of anxiety and depression, especially in the presence of coexisting migraine. However, the anxiety and depression can improve during remission periods.

Keywords: Anxiety; Cluster headache; Depression; Headache; Migraine.

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Conflict of interest statement

Drs. BS Kim, PW Chung, BK Kim, MJ Lee, JW Park, JY Ahn, DW Bae, TJ Song, JH Sohn, K Oh, D Kim, JM Kim, SK Kim, YJ Choi, JM Chung, HS Moon, CS Chung, and KY Park report no conflict of interest.

Dr. Chu was involved as a site investigator for a multicenter trial sponsored by Otsuka Korea, Allergan, Ildong Pharmaceutical Co., LTD, Novartis International AG, and Eli Lilly and Company. He worked an advisory member for Teva, and received lecture honoraria from Allergan Korea, Handok-Teva and Yuyu Pharmaceutical Company in the past 24 months.

Dr. Cho was involved as a site investigator of multicenter trial sponsored Otsuka Korea, Allergan, Ildong Pharmaceutical Co., LTD, Novartis International AG, Eli Lilly and Company. Parexel Korea Co., Ltd., and and received lecture honoraria from Allergan Korea, WhanIn Pharm Co., LTD, Handok-Teva and Yuyu Pharmaceutical Company.

Figures

Fig. 1
Fig. 1
Flowchart for recruitment
Fig. 2
Fig. 2
a Changes in anxiety and depression scores between active cluster bouts and remission periods. b Changes in the proportion of patients with moderate-to-severe anxiety and depression between active cluster bouts and remission periods. Abbreviations: GAD-7, Generalized Anxiety Disorder (7-item scale); PHQ-9, Patient Health Questionnaire (9-item scale)
Fig. 3
Fig. 3
Proportions of patients with a more than 50% reduction in anxiety and depression according to prespecified subgroups. Abbreviations: GAD-7, Generalized Anxiety Disorder (7-item scale); PHQ-9, Patient Health Questionnaire (9-item scale)
See this image and copyright information in PMC

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