The diagnostic order of migraine-depression comorbidity associates with physical, mental, and social disability.

Abstract

Objectives/background: There is a known bidirectional association between migraine and depression; however, potential effects of the diagnostic trajectory of the diseases are not known. Therefore, we investigated the association of the diagnostic order of migraine and depression with the physical and mental health status of groups with different disease trajectories.

Methods: A sample of the UK Biobank was used (n = 327,234; 51.2% female, median age: 58 years) in our cross-sectional study. Based on ICD-10 codes from electronic health record, the following groups were compared: first migraine, then depression (M-D, n = 2036), first depression, then migraine (D-M, n = 1217), only migraine (M, n = 13,318), only depression (D, n = 33,831), and controls (C, n = 276,832). Data covered general descriptive data, socioeconomic status, lifestyle and health, social support, and mental health, collected mostly between 2006 and 2010.

Results: Bonferroni-corrected significant results (p < 0.001) emerged between the groups, adjusted for sex. D-M patients showed the highest level of sleeping problems (odds ratio [OR] = 3.26, 95% confidence interval [CI]: 2.72-3.92), neuroticism (β = 3.26, 95% CI: 3.09-3.44), stress (OR = 3.68, 95% CI: 3.19-4.25), the worst rated overall health (OR = 22.93, 95% CI: 17.72-29.68), and the highest Townsend Deprivation Index (β = 0.76, 95% CI: 0.59-0.93). The D-M and M-D patients shared the highest body mass index (β = 1.57, 95% CI: 1.31-1.83; 1.3, 95% CI: 1.09-1.5, respectively) and the lowest physical activity (OR = 0.55, 95% CI: 0.47-0.64; 0.59, 95% CI: 0.53-0.67, respectively). The D patients reported the lowest level of education (OR = 0.71, 95% CI: 0.68-0.73) and income (OR = 0.29, 95% CI: 0.27-0.31), and two comorbid groups showed similarly low values.

Conclusion: Our study suggests that the diagnostic order is an important feature of migraine-depression comorbidity by revealing that the depression diagnosed first associates with a stronger physical, mental, and social disability even among comorbid cases and this needs specific attention by clinicians.