Psychiatric Morbidity in Migraine and its Impact on Quality of Life: A Hospital-based Cross-sectional Study

Introduction: Migraine is a disabling headache disorder. Many psychiatric disorders co-exist with migrainous headache which largely remain undiagnosed leading to greater risk of morbidity and significantly impacts quality of life. Migraine patients are particularly at risk for mood and anxiety disorders which negatively impact the prognosis and poor headache outcome. Hence, defining the exact nature of underlying psychiatric conditions in migraine are relevant issues in the clinical practice. Aim: To find the association of psychiatric morbidity and quality of life in migrainous (with and without aura) and non-migrainous subjects and to assess the correlation between severity of migraine and quality of life. Materials and Methods: It was a hospital based cross-sectional study conducted amongst the patients and their healthy attendants visiting the Psychiatry OPD of Rajindra Hospital, Patiala from May 2018 to April 2019, after obtaining ethical clearance. A total of 392 subjects of both gender and in the age group 18-65 years, who gave informed consent were enrolled. Group 1 (n=196) consisted of cases i.e., migrainous patients as per International Classification of Headache Disorders 3rd Edition, beta version (ICHD-3) criteria and Group 2 (n=196) consisted non-migrainous controls. Psychiatric morbidity was assessed using Mini International Neuropsychiatric Interview (MINI) and confirmed on International Classification of Diseases 10th edition (ICD-10). Severity of migraine was assessed on Migraine Disability Assessment Test (MIDAS) and its impact on quality of life (QOL) by using 36 Item Short Form questionnaire (SF-36 questionnaire). Variables were compared using the independent t-test and chi-square test. Pearson correlation was used to study the relationship between severity of migraine with QOL in subjects with and without psychiatric morbidity. Results: Psychiatric morbidity was found among 65.3% (n=128) and 19.9% (n=39) subject in Group 1 and Group 2, respectively. Major Depressive Disorder (37.2%, n=73) was the most common psychiatric morbidity, followed by Generalized Anxiety Disorder (8.7%, n=17), Manic episode and Panic disorder each (5.1%, n=10), Hypomanic episode & Obsessive Compulsive Disorder each (3.1%, n=6), Dysthymia (2%, n=4) and Post Traumatic Stress disorder (1%, n=2). Between groups, the association of migraine with Major Depressive Disorder (p <= 0.001), General Anxiety Disorder (GAD) (p=0.024), Manic episode (p=0.005), Hypomanic episode (p=0.048) was statistically significant but more in migrainous patients than non-migrainous subjects. Migrainous patients had lower QOL in physical and psychological health domains of SF-36 than in non-migrainous subjects. Furthermore, migrainous patients with or without psychiatric morbidity had significantly negative correlation in all domains of SF-36. Conclusion: Psychiatric morbidity was significantly higher in migrainous patients than non-migrainous subjects with poor quality of life in migrainous patients causing significant disability with an increase in severity of migraine.