Children with migraines have elevated risk of anxiety and depressive symptoms and disorders

 1. In a systematic review and meta-analysis, children and adolescents with migraine are at higher risk of anxiety and depression symptoms and disorders compared with patients without migraines.

2. Pediatric patients with migraines may therefore benefit from routine screening for anxiety and depression.

Evidence Rating Level: 2 (Good)

Study Rundown: Migraines are common in children and adolescents and can be disabling for many patients. Experts suggest that children with migraines may be at an elevated risk of anxiety and depression, although high-quality studies confirming this association are lacking. This systematic review and meta-analysis of 51 studies sought to evaluate if an association between migraine and anxiety/depressive symptoms exists. Meta-analysis suggested that migraines had a significant association with anxiety symptoms, depressive symptoms, and higher odds of anxiety and depressive disorders. Due to study heterogeneity, systematic review could not assess whether having anxiety and depressive symptoms or disorders affect migraine outcomes or incidence. An important limitation of this study is the lack of controlling for covariates such as headache frequency and sex. In addition, most studies included in the meta-analysis reported only unadjusted associations, thereby increasing risk of confounding bias. Overall, this study provides evidence that children with migraines are at increased risk for depression and anxiety and should therefore undergo regular screening for these symptoms and disorders.

Click here to read the article in the JAMA Pediatrics

Relevant Reading: Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies

In Depth [systematic review and meta-analysis]: This systematic review included all study types with children < 18 years of age with migraines that assessed symptoms and disorders on the spectrum of anxiety disorders, depressive disorders, and trauma- and stressor-related disorders, according to the DSM-5. 80 studies were included in the systematic review, and 51 were included in the meta-analysis. Outcomes included symptoms and disorders of anxiety, depression, and mixed internalizing (anxiety and depression). Results of outcomes were stratified by practice setting including clinical and community/population-based samples. Migraines had a statistical association with anxiety symptoms (standard mean difference [SMD] 1.13; 95% CI, 0.64-1.63) and depressive symptoms (SMD, 0.67; 95%CI, 0.46-0.87). In addition, children with migraines had higher odds of anxiety (OR 1.93, 95% CI 1.49-2.50) and depressive disorders (OR 2.01, 95% CI 1.46-2.78). Outcomes did not differ when results were stratified by practice setting. There were 20 studies assessing the association between internalizing symptoms or disorders and migraine outcomes/severity, but heterogeneity of studies and outcomes precluded any meta-analyses or conclusions.

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