Impact of anxiety and depression on migraine-related disability: Results from the Headache Assessment via Digital Platform in the United States (HeAD-US) study.

Background: Anxiety and depression are common psychiatric comorbidities among people with migraine and may increase disease burden. However, their impact on both disability during and between attacks is not well-characterized in real-world studies. We aimed to assess the relationship between anxiety and depressive symptoms and migraine-related disability and interictal burden in a large real-world sample.

Methods: We used cross-sectional data from 6267 participants with migraine recruited using the Migraine Buddy app to create the Headache Assessment via Digital Platform in the United States (HeAD-US) registry. Disability and interictal burden were assessed using the Migraine Disability Assessment Scale (MIDAS) and the Migraine Interictal Burden Scale (MIBS), respectively. Anxiety and depressive symptoms were evaluated using the 4-item Personal Health Questionnaire (PHQ-4). Participants were categorized into four subgroups: anxiety symptoms only, depressive symptoms only, both, or neither. Negative binomial regression was used to explore associations with disability or burden.

Results: Participants were 41.5 ± 13 years old; 90.8 % were women. Coexisting anxiety and depression were more common in chronic than episodic migraine (30.3 % vs. 20.0 %, p < 0.001). In adjusted models, anxiety symptoms alone were associated with 8.7 % increases in MIDAS and 11.7 % increases in MIBS scores; depressive symptoms alone with 28.4 % and 15.5 % increases, respectively; and coexisting anxiety and depressive symptoms with 32.5 % higher MIDAS and 22.6 % higher MIBS scores (all p < 0.05).

Conclusions: In this large real-world study, anxiety and depression were more prevalent in chronic migraine and independently associated with greater migraine-related disability and interictal burden. Findings extend previous results to a digital health cohort.