Depression and Anxiety: Effect on the Migraine–Obesity Relationship


  • Gretchen E. Tietjen MD,

  • B. Lee Peterlin DO,

  • Jan L. Brandes MD,

  • Faizan Hafeez MD,

  • Susan Hutchinson MD,

  • Vincent T. Martin MD,

  • Rima M. Dafer MD, MPH,

  • Sheena K. Aurora MD,

  • Michael R. Stein MD,

  • Nabeel A. Herial MD, MPH,

  • Christine Utley MSN, CNP,

  • Leah White MPH,

  • Sadik A. Khuder MPH, PhD

  • From the University of Toledo College of Medicine, Toledo, OH, USA (Drs. Tietjen, Hafeez, Herial, Ms. Utley, Ms. White, and Dr. Khuder); University of Medicine and Dentistry of New Jersey, Stratford, NJ, USA (Dr. Peterlin); Nashville Neuroscience Group, Nashville, TN, USA (Dr. Brandes); Women's Medical Group of Irvine, Irvine, CA, USA (Dr. Hutchinson); University of Cincinnati, Cincinnati, OH, USA (Dr. Martin); Loyola University Medical Center, Maywood, IL, USA (Dr. Dafer); Swedish Headache Center, Seattle, WA, USA (Dr. Aurora); and John Muir Medical Center, Walnut Creek, CA, USA (Dr. Stein).

Address all correspondence to Dr. Gretchen E. Tietjen, 3120 Glendale Avenue, RHC 1450, Department of Neurology, The University of Toledo-Health Science Campus, Toledo, OH 43614, USA.


Objective.—To discern the effects of depression and anxiety on the migraine–obesity relationship.

Background.—Migraine and obesity are highly prevalent conditions and are both independently linked to psychiatric conditions, mainly depression and anxiety.

Methods.—Data are from an ongoing cross-sectional multicenter study on comorbid conditions in clinic patients seeking treatment for headache. The diagnosis of migraine was determined by the examining physician based on the International Classification of Headache Disorders (ICHD)-II criteria. Participants completed a self-administered questionnaire with information on demographics, headache features, and physician-diagnosed comorbid medical and psychiatric disorders. The questionnaire included scales for measuring current depression (PHQ-9), anxiety (BAI), and headache-related disability (HIT-6).

Results.—A total of 721 migraineurs (88% women) from 8 different headache treatment centers were included in this study (mean age = 42 years, SD = 12). Aura was reported in 45% and chronic headache (≥15 headache days/month) in 35% of the participants. Prevalence of obesity in our population was 30% and only 38% had normal weight. Obesity was more common in men (P= .004), African Americans (P= .026), and in lower education (P= .05) and household income (P=.05) groups. Current depression (PHQ-9 score ≥10) was noted in 42% and current anxiety (BAI score ≥8) in 70% of the obese migraineurs. In ordinal logistic regression, obesity was associated with current depression (odds ratio [OR]= 1.86, 95% confidence interval [CI]: 1.25 to 2.78) and anxiety (OR = 1.58, 95% CI: 1.12 to 2.22). A significant effect of depression on the body mass index (BMI) and headache frequency relationship was noted. Obese migraineurs with depression were more likely to have higher headache frequency (OR = 4.16, 95% CI: 1.92 to 8.99) and headache-related disability (OR = 7.10, 95% CI: 2.69 to 18.77) compared to normal weight migraineurs without depression. Similarly, obese migraineurs with anxiety were more likely to have higher headache frequency (OR = 1.96, 95% CI: 1.07 to 3.61) and headache-related disability (OR = 3.59, 95% CI: 1.64 to 7.86) compared to normal weight migraineurs without depression. Compared to migraineurs with either current depression or anxiety, those with both these conditions were more likely to have higher headache frequency (OR = 3.18, 95% CI: 1.86 to 5.43) and headache disability (OR = 6.13, 95% CI: 2.58 to 14.59).

Conclusion.—Depression and anxiety were common in obese migraineurs. The relationship of obesity with migraine frequency and migraine-related disability is modified by depression and by anxiety, with the strongest effect observed in migraineurs with both depression and anxiety.