Women with chronic headache, especially migraines, are significantly more likely than women with episodic headache to have symptoms of major depression, according to an article in the January 9 issue of Neurology.

The study involved 1032 women at headache clinics in five US states. Of the women surveyed, 593 reported episodic headache (fewer than 15 headaches per month) and 439 had chronic headache (more than 15 headaches per month). Ninety percent of the women were diagnosed with migraines.

The study found women with chronic headache were four times more likely than those with episodic headache to report symptoms of major depression. Chronic headache sufferers were also three times more likely to report a high degree of symptoms related to headache, such as low energy, trouble sleeping, nausea, dizziness, pain or problems during intercourse, and pain in the stomach, back, arms, legs, and joints.

Among patients diagnosed with severely disabling migraine, the study found the likelihood of major depression increased 32-fold if the patient also reported other severe symptoms.

“Painful physical symptoms may provoke or be a manifestation of major depression in women with chronic headache, and depression may heighten pain perception,” said study author Gretchen Tietjen, MD with the University of Toledo-Health Science Campus and a member of the American Academy of Neurology. “This relation between migraine and major depression suggests a common neurobiology.”

Tietjen says studies are underway to test whether severe headache, severe physical symptoms and major depression may be linked through dysfunction of serotonin in the central nervous system.

“Regardless of what’s causing the link between migraine and depression, psychiatric disease such as depression complicates headache management and can lead to poorer outcomes for headache management,” said Tietjen.