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Published on: April 26, 2024

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

Daniel Baksa1,2,3,4, Nora Eszlari1,2,3, Dora Torok1,2,3

  • 1Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.

Headache
|August 20, 2026
PubMed

Insights

The diagnostic order of migraine and depression significantly impacts patient health. Diagnosed depression first (D-M) is linked to greater physical, mental, and social disability in comorbid cases.

Area of Science:

  • Neurology
  • Psychiatry
  • Public Health

Background:

  • A bidirectional association exists between migraine and depression.
  • The impact of diagnostic order on health outcomes in comorbid cases is unknown.

Purpose of the Study:

  • To investigate how the diagnostic order of migraine and depression influences physical and mental health.
  • To compare health status across different diagnostic trajectories: migraine then depression (M-D), depression then migraine (D-M), only migraine (M), only depression (D), and controls (C).

Main Methods:

  • Cross-sectional study using UK Biobank data (n=327,234).
  • Analysis of ICD-10 codes from electronic health records to define patient groups.
  • Comparison of descriptive data, socioeconomic status, lifestyle, social support, and mental health.

Main Results:

  • The depression-first (D-M) group exhibited higher sleep problems, neuroticism, stress, poorer overall health, and greater socioeconomic deprivation.
  • Both comorbid groups (D-M and M-D) showed higher BMI and lower physical activity compared to controls.
  • Individuals with only depression (D) reported lower education and income.

Conclusions:

  • The diagnostic order is a critical factor in migraine-depression comorbidity.
  • Depression diagnosed first is associated with more severe physical, mental, and social disability.
  • Clinicians should consider the diagnostic sequence for targeted interventions.
Abstract

Keywords:
depressiondiagnostic ordermigraineneuroticismsocioeconomic statusstress

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