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Migraine and Depression Genetically Linked

January 15, 2010 — A new study suggests that the strong relationship between migraine, particularly migraine with aura, and depression may be explained at least in part by shared genetic factors.

“Twin- and family-based studies have shown that both migraine and depression have a strong genetic basis,” report the investigators led by Anine Stam, MD, from Leiden University in the Netherlands.

“Identification of common genetic factors may significantly improve insight into the molecular basis of these common and highly disabling episodic brain disorders,” the researchers note.

The new study is published in the January 13 issue of Neurology.

 

January 15, 2010 — A new study suggests that the strong relationship between migraine, particularly migraine with aura, and depression may be explained at least in part by shared genetic factors.

“Twin- and family-based studies have shown that both migraine and depression have a strong genetic basis,” report the investigators led by Anine Stam, MD, from Leiden University in the Netherlands.

“Identification of common genetic factors may significantly improve insight into the molecular basis of these common and highly disabling episodic brain disorders,” the researchers note.

The new study is published in the January 13 issue of Neurology.

In an accompanying editorial, Andrew Ahn, MD, from the University of California at San Francisco, and Tetsuo Ashizawa, MD, from the University of Florida in Gainesville, applaud the study authors on their innovative approach in explaining the comorbidity of migraine and depression.

“The frequent association between migraine headache and mood disorders represents a common and at times challenging clinical scenario,” the editorialists point out. “This finding informs our understanding of the heritability of these 2 disorders and prompts us to make note of our migraine patients’ family histories of both headache and depression.”

Family History of Headache and Depression Important

The investigators studied members of a geographically and genetically isolated population in southwest Holland. Participants were part of the Erasmus Rucphen Family project, a cohort of descendants from 22 couples. The couples are related through previous generations, and study participants are all members of a large extended family.

Researchers screened the more than 2600 people by questionnaire and follow-up telephone interview. They identified 360 with a history of migraine.

Investigators identified depression using 2 measures — the Center for Epidemiologic Studies Scale and the Hospital Anxiety and Depression Scale. More than 580 participants had depression.

The study authors then combined these diagnoses and used a statistical algorithm to determine to what degree the presence of migraine and depression could be explained by genetics.

They found that patients with migraine with aura were the most likely to be depressed.

Table. Depression in Migraine Patients

Patients Depression, % Odds Ratio (95% Confidence Interval) P Value
Controls (n = 617) 13 1.00  
Migraine, no aura (n = 209) 21 1.29 (0.98 – 1.70) .07
Migraine with aura (n = 151) 32 1.70 (1.28 – 2.24) <.001

 

“A few points merit caution in the conclusions of this study,” the editorialists note. “First, the observed heritability of migraine with aura in the Dutch isolate population, 0.96, or 96%, is high, and greatly exceeds prior estimates, which range from 0.65 to 0.79.”

Second, they add, the confidence intervals around the heritability estimate of migraine with aura are broad, suggesting that there could be substantial statistical uncertainty, which limits the ability to detect a small reduction by depression.

And finally, the differences in the heritability of migraine are much more divergent than seen in previous estimates, the editorialists caution. “These results require further confirmation by a similarly designed study in another isolate population.”

Confirmation, they note, would suggest that at least 1 pathophysiologic process could underlie both of these disabling disorders, with other processes contributing to the distinct features of each. “This hypothesis may lead to better therapeutic strategies when these disorders are present together.”

This study was supported by the Netherlands Organization for Scientific Research, the European Community, and the Centre for Medical Systems Biology. Coauthor Dr. Michel Ferrari has received funding from Almirall, Coherex, Colucid, Eisai, GlaxoSmithKline, Linde, MAP, Medtronic, Menarini, Merck Sharp & Dohme, Minster, Pfizer, and St. Jude. Senior author Dr. Gisela Terwindt received funding from Merck Sharp & Dohme and Janssen-Cilag. Editorialist Dr. Andrew Ahn’s spouse is an employee of Genentech. Dr. Tetsuo Ashizawa holds a US patent for epitope-specific immunosuppression. He also receives license fee payments from the Baylor College of Medicine for a DNA test. His spouse holds stock in Interpath. Neurology.

Journalist

Allison Gandey

Allison Gandey is a journalist for Medscape. She is the former science affairs analyst for the Canadian Medical Association Journal. Allison, who has a master of journalism specializing in science from Carleton University, has edited a variety of medical association publications and has worked in radio and television. She can be contacted at [email protected]

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