Аннотация:A number of large-scale epidemiological studies have demonstrated the comorbidity of migraine and depression. Depression is a confirmed modifiable risk factor for chronic migraine. Nevertheless, screening for depression is not included in the migraine management guidelines and standards.
The goal of the study was to evaluate the long-term effect of depression on the course of migraine, as well as the efficacy and safety of antidepressant therapy in patients with depression associated with migraine and the effects of this therapy on the prognosis of migraine.
This observational, non-interventional study enrolled 544 patients suffering from migraine and assessed the clinical course of migraine and depression. Evaluations were conducted at the initial visit of a patient whose main complaint was headache (Visit 1), at 6 months (Visit 2), and at 12 months (Visit 3). After that, telephone interviews were conducted once a year (Visits 5, 6, 7, 8) to ask for the number of days of headache. Antidepressant therapy was administered in 240 patients with depression, and its long-term effect was later assessed.
The longitudinal analysis revealed 6 variants of the course of migraine: persistent episodic migraine, migraine in remission, progression from episodic to chronic migraine, reversion of chronic migraine to episodic migraine, persistent chronic migraine, and recurring (relapsing) chronic migraine. The presence of depression and cutaneous allodynia are predictors of persistent and recurring chronic migraine. In patients with chronic migraine combined with depression, several groups of antidepressants are effective in reducing the number of days of headache: tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), selective serotonin – norepinephrine reuptake inhibitors (SSNRI), and serotonin reuptake antagonists / inhibitors (SRAI). The most pronounced effect was observed with the TCA amitriptyline, the smallest effect was obtained with the SSRI paroxetine. Intermediate results were achieved with the SSNRI venlafaxine and the SRAI trazodone. Trazodone is better tolerated compared with other antidepressants, particularly during the first few weeks of treatment. Screening for and treatment of depression should be included in the migraine management standards.
