Page 42 - The clinical aspects and management of chronic migraine Judith Anne Pijpers

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Chapter 2
Discussion
This is the first study differentiating in a large sample of migraine patients for symptom dimensions of depression and anxiety. In comparison with healthy controls and persons with past or current psychopathology, affective disorder symptoms in migraine are specifically associated with higher scores on the dimension somatic arousal which covers symptoms of hyperarousal. Furthermore, the association between MASQ-D30 scores and migraine frequency, which can be considered as an indication of migraine severity, is the strongest on the somatic arousal subscale. Besides migraine frequency, we show that cutaneous allodynia is associated with higher scores on all three symptom dimensions as well.
Our finding that migraine is particularly associated with the somatic arousal dimension, is in accordance with that of several other somatic disorders. Association studies investigating the relationship of depression with chronic diseases like diabetes, obesity, and cardio-vascular disease often show that somatic-affective symptoms of depression rather than cognitive-affective symptoms are related to somatic disease.25-28 Therefore, it is often hypothesized that the association between a somatic disease and depression is primarily through the somatic-affective dimension of depression, the so-called somatic depression.29;30
One might also argue that part of the comorbidity between migraine and affective disorders could be due to overlapping symptomatology. Some of the characteristic features of migraine attacks, such as nausea, loss of energy, anhedonia, and sleep disturbances, could lead to misclassification of depressive disorder in migraine patients. However, the association of migraine and depression is still present when questionnaires focusing on the non- somatic aspects of depression are applied, such as the Hospital Anxiety and Depression Scale).24 Furthermore, the current study clearly shows that the symptom profile of affective disorders in migraine patients differs from healthy controls for all three dimensions of the MASQ-D30 questionnaire, not only for the somatic arousal dimension. Therefore, our study shows that affective disorders in migraine patients cannot be fully explained by somatic depression or overlapping symptomatology.