Pediatric Patients With Migraine More Vulnerable to Anxiety, Depression

Children and adolescents with migraine are more likely to have anxiety or depressive symptoms compared with their peers without migraine, according to study findings published in JAMA Pediatrics.

Researchers in Canada conducted a systematic review and meta-analysis of PubMed, Embase, CINAHL, and PsychINFO databases from inception to March 28, 2022 to analyze the relationship between internalizing symptoms and disorders and diagnosis of migraine in children and adolescents. They included 80 of 4946 identified studies in their review with 51 of the 80 studies included in the meta-analysis.

The meta-analysis revealed that migraine correlated with anxiety and depressive symptoms in children and adolescents compared with healthy control individuals (standardized mean difference [SMD] for anxiety, 1.13; 95% CI, 0.64-1.63 and SMD for depressive symptoms, 0.67; 95% CI, 0.46-0.87).

Children and adolescents with migraine were more likely to have anxiety and depressive symptoms than those without migraine (odds ratio [OR], 2.01; 95% CI, 1.46-2.78).

The researchers stated that this association between migraine and anxiety and depressive symptoms is “likely bidirectional and multifactorial.” Children and adolescents who experience the pain of migraine and internalize their symptoms may also experience sleep disturbances and withdrawal from activities. Experiencing migraines may also reinforce cognitive patterns of negativity bias and attention bias. Additionally, genetic factors have been identified that link migraine, anxiety, and depression.

After further examining the relationship between migraine and anxiety and depression, the researchers could not make clear associations between having anxiety or depressive symptoms and migraine outcomes or incidence.

Seven of the 8 studies that reported on depressive symptoms and migraine outcomes indicated that higher depressive symptoms correlated with worse migraine outcomes. However, the researchers were unable to pool the data to clearly make this conclusion.

Only 2 studies reported findings on the association between migraine incidence and baseline internalization of symptoms, restricting the formation of any strong conclusions because of the small study number.

“Children and adolescents with migraine were at higher risk of anxiety and depression symptoms and disorders compared with healthy controls,” the researchers noted. “It may be beneficial to routinely screen children and adolescents with migraine for anxiety and depression in clinical practice,” they surmised.

Study limitations included study heterogeneity, the inability to stratify results based on data such as headache frequency and sex due to limited reporting in included studies, the risk of bias in included studies due to unmeasured confounding variables, and poor study quality of most included studies.