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Personality and Migraine

In this issue of Headache, Breslau and Andreski present a provocative paper exploring the association between migraine and neuroticism while controlling for history of comorbid psychiatric disorder. Recent epidemiologic studies have noted associations between migraine and psychiatric disorders, primarily major depression and anxiety disorders.1-8 Breslau et al have recently examined the association between migraine and major depression in a longitudinal study.8 They convincingly show that the previously-observed cross-sectional association between migraine and depression is most likely bidirectional. Bidirectionality suggests that each disorder increases the risk for development of first onset of the other disorder. This evidence that major depression increases the risk for migraine and that migraine increases the risk for major depression suggests, or at least strengthens, the hypothesis that these disorders have a shared etiology.9 The psychiatric comorbidity studies are community-based to guard against selection bias. They have also used explicit diagnostic criteria and devised reliable structured interviews for use in large nonclinical samples. To the best of my knowledge, no studies have examined frequency of migraine or coexisting tension-type headache as covariates.