• Filippo Baldacci, Cinzia Lucchesi, Martina Cafalli, Michele Poletti, Martina Ulivi, Marcella Vedovello, Martina Giuntini, Sonia Mazzucchi, Eleonora Del Prete, Andrea Vergallo, Angelo Nuti, and Sara Gori.
• Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy. Electronic address: filippo.baldacci@unipi.it.
• Clin Neurol Neurosurg. 2015 May 1;132:74-8.

BackgroundMigraine, anxiety and depression often coexist. A "neurolimbic" model of migraine has been recently proposed accounting for a dynamic influence of pain, mood and anxiety on the migraine disease. However, very few data exist concerning clinical migraine features in patients reporting anxiety-depression symptoms.ObjectiveAim of our study was to test differences in clinical migraine features between migraineurs with anxiety-depression symptoms and migraineurs without ones.Materials And MethodsWe recruited 200 consecutive migraineurs. Other primary headaches comorbidity and migraine prophylaxis were exclusion criteria. Each patient was interviewed following a structured questionnaire including general features about migraine, triggers, allodynia. Anxiety and depression symptoms were evaluated in each patient by two brief self-reported scales: the generalized anxiety disorder 7-item scale (GAD-7) and the Patient Health Questionnaire 9-item scale (PHQ-9). A cut-off of 5 in both the GAD-7 and the PHQ-9 was considered positive for the presence of anxiety-depressive symptoms.ResultsOne hundred and one patients (51.5%) had anxiety-depression symptoms (GAD-7 and PHQ-9 ≥ 5). They reported a more headaches/month (p = 0.004), higher number of triggers (p < 0.001), and were more allodynic (p = 0.005). In a binary logistic regression model triggers and allodynia made a unique statistical contribution on reporting anxiety-depression symptoms.ConclusionOur results showed that the presence of anxiety-depression symptoms affects migraine clinical presentation. They are associated with enhanced migraine triggers susceptibility, more ictal allodynic symptoms as well as more headaches/month. An altered sensation in migraineurs with anxiety-depression symptoms could be a result of a lower pain threshold and an increased cortical excitability in a broader context of a neurolimbic dysfunction.Copyright © 2015 Elsevier B.V. All rights reserved.

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