History of Migraine May Increase Risk of Anxiety, Depression During Pregnancy

Migraine may be a risk factor for anxiety in mid-pregnancy, and for mixed symptoms of peripartum depression and anxiety in late pregnancy, according to results of a prospective cohort study. Findings were published in the Journal of Affective Disorders.

Depression is one of the most common psychiatric conditions in the world, while “during pregnancy and the postpartum period, women are especially susceptible to depression, which at this period is referred to as peripartum depression,” researchers explained.

The exact underlying mechanism of increased risk of depression during this period remains unknown, although some have proposed the rapid drop in hormones after childbirth could increase depression susceptibility. Others hypothesized inflammation may play a role as shifts in inflammatory markers have been observed both during pregnancy and in the postpartum period.

In addition, “women with peripartum depression who subsequently develop treatment-resistant depression are more likely to suffer from painful comorbidities,” one of which is migraine.

To better understand symptoms of depression and anxiety separately and combined at 3 time points during and after pregnancy, researchers assessed data from a population-based cohort of women with and without a history of migraine.

The sample consisted of 4831 women enrolled in the Biology, Affect, Stress, Imaging and Cognition cohort in Sweden. As part of the study individuals completed web-based questionnaires and the Edinburgh Postnatal Depression Scale (EPDS) at gestational weeks 17 and 32 and postpartum week 6.

Of the participants with scores available at week 17, 847 (18%) reported a history of migraine. “For those with an EPDS score available at 32 weeks of pregnancy, 17% reported having a history of migraine (n = 803 out of 4602). The corresponding percentage for those with a score available at 6 weeks postpartum was 17% (n = 761 out of 4371),” authors wrote.

Crude estimates revealed migraine was associated with separate and mixed symptoms of depression and anxiety at most time points.

Adjusted analyses showed “migraine was associated with anxiety at week 17 (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.11-2.54) and with mixed depression and anxiety at week 32 (OR 1.45; 95% CI, 1.06-1.99).”

Compared with those without migraine, a higher proportion of those with the condition reported a history of smoking and depression, while a lower proportion of migraineurs had higher education and reported working.

According to authors, the study is the first to assess associations between migraine history and mixed symptoms of depression and anxiety during and after pregnancy, and findings indicate underlying pathogeneses of peripartum depression and anxiety may vary throughout this period.

Self-reported history of migraine in this study marks a limitation, in addition to the fact measures of depression and anxiety were not based on clinical assessments. Residual confounding may have also occurred, and future larger studies are warranted.

“Our results suggest that different pathophysiological mechanisms may be responsible for the association between migraine and depression and/or anxiety at different time points throughout the peripartum period,” researchers concluded. “Future studies are needed to determine which mechanisms are responsible for these differences.”

Reference

Welander NZ, Mwinyi J, Asif S, Schiöth HB, Skalkidou A, and Fransson E. Migraine as a risk factor for mixed symptoms of peripartum depression and anxiety in late pregnancy: a prospective cohort study. J Affect Disord. Published online September 4, 2021. doi:10.1016/j.jad.2021.08.119