The association between major depression and headache: results of a longitudinal epidemiologic study in youth

Retrospective epidemiologic research in adults suggests that a long-term association between major depression and headache arises during childhood or adolescence. This study uses data from a prospective epidemiologic study to examine the association between major depression and headache from late childhood into early adulthood. An epidemiologically selected sample of 776 youth, aged 9-18, was assessed psychiatrically in 1983 using DISC interviews with both youth and parent informants. Reassessments were conducted in 1985-1986 and 1992. Current and past histories of functionally impairing migraine or chronic headache were elicited in both 1985-1986 and 1992. Regression analyses examined the relationships between major depression and headache status. The prevalence of current functionally impairing headache was approximately 10% in both 1985-1986 and 1992. There were lifetime and cross-sectional associations between headache and major depression. Headache was approximately twice as common in depressed adolescents compared with nondepressed adolescents. Major depression in adolescents, without current or past headache, prospectively predicted the new onset of headaches in young adulthood. Among adolescents who had no history of chronic impairing headache in 1985-1986, those with current major depression faced a nearly tenfold increased risk of developing such headaches at some time during the next 7 years. Consistent with findings of retrospective studies among adults, a longitudinal/ developmental relationship between major depression and functionally impairing headache was found in this prospective epidemiologic study of youth. These findings suggest that (1) neurochemical and pharmacologic commonalities between depression and headache should receive further investigation and that (2) it may be clinically useful to inquire about family history of headache syndromes in adolescents with major depression because such questioning may provide insight about the risk of subsequent functionally impairing headache in a depressed adolescent.