Impact of Depression and Anxiety Symptoms on Patient-Reported Outcomes in Patients With Migraine: Results From the American Registry for Migraine Research (ARMR)

Background and Objectives: The association between migraine, depression, and anxiety has been established, but the impact of these psychiatric comorbidities on functional impairment in people with migraine has been under-investigated. The purpose of this cross-sectional observational study was to investigate the relationship between anxiety and depression symptoms on migraine-related disability, pain interference, work interference, and career success in a cohort of patients with migraine. Methods: This analysis included 567 migraine patients who had been enrolled into the American Registry for Migraine Research (ARMR) between February 2016 and June 2019. Patients completed the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-2 (PHQ-2) to measure symptoms of anxiety and depression, respectively. Patients completed the Migraine Disability Assessment Scale (MIDAS), Pain Interference (PROMIS pain short) questionnaire, and Work Productivity and Activity Interference (WPAI) questionnaire to measure levels of functional impairment at work and in daily activities. In addition, patients answered questions designed for ARMR regarding education and career interference. Models were created to describe the relationship between severity of psychiatric symptoms (anxiety and depression), and each outcome of interest (WPAI, MIDAS, pain interference, reporting that migraine had interfered with career success). Each model was controlled for age, sex, headache frequency, years with migraine, and average headache intensity. Results: Among the 567 patients with migraine, mean (SD) age was 47.1 (13.7), 87.3% were female, and average headache frequency was 19.1 (9.3) days/month. PHQ-2 scores were positively associated with scores on MIDAS (b = 0.06, SE = 0.01, P ≤.001), pain interference (b = 1.4, SE = 0.2, P '.001), and WPAI including absenteeism (b = 0.16, SE = 0.04, P =.007), presenteeism (b = 2.7, SE = 1.1, P =.012), overall work productivity impairment (b = 3.7, SE = 1.2, P =.001), and activity impairment (b = 3.0, SE = 1.2, P =.009). PHQ-2 scores were also associated with reporting that migraine interfered with career success (b = 0.34, SE = 0.08, P ≤.001). GAD-7 scores were not associated with MIDAS, pain interference, WPAI, or reduced career success. Conclusions: Severity of depression symptoms in patients with migraine is associated with migraine-related disability, work interference, pain interference, and reduced career success. Patients with more severe symptoms of depression are more likely to have greater functional impairment. A management approach that addresses depression in those with migraine may lead to improvements in patient functioning.