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Results From the Baltimore Epidemiologic Catchment Area Follow-up Study

Karen L. Swartz, MD; Laura A. Pratt, PhD; Haroutune K. Armenian, MD, DrPH; Li Ching Lee, MS; William W. Eaton, PhD

Arch Gen Psychiatry. 2000;57:945-950.

Background  The cross-sectional relation between migraine headaches and affective disorders has been demonstrated in studies of clinical and community populations. Few studies have investigated the prospective relation between psychiatric disorders and migraine headaches.

Methods  A prospective follow-up of the Baltimore, Md, cohort of the Epidemiologic Catchment Area Study assessed psychopathologic features in 1981 and again between 1993 and 1996. Interviews included a history of headaches at baseline and self-reported assessment of migraine headaches at follow-up. Risk estimates for incident migraine headaches by 1981 demographic variables and psychopathologic features were calculated. The cross-sectional association between prevalent migraine and lifetime psychiatric diagnoses was estimated.

Results  In the at-risk population of 1343, there were 118 incident cases of migraine headaches. The age- and sex-specific incident rates of migraine headaches followed the expected patterns, with younger age and female sex identified as risk factors. In cross-sectional analyses, major depression (odds ratio, 3.14; 95% confidence interval, 2.03-4.84) and panic disorder (odds ratio, 5.09; 95% confidence interval, 2.65-9.79) had the strongest associations, and alcohol and other substance abuse were not associated. In logistic regression models including age, sex, and psychiatric illness in 1981, only phobia was predictive of incident migraines (odds ratio, 1.70; 95% confidence interval, 1.11-2.58). Affective disorders were not predictive of incident migraine headaches. Including a history of tricyclic antidepressant use did not change the results.

Conclusions  There is a strong cross-sectional relation between affective disorders and migraine headaches in this cohort. However, there is no association between antecedent affective disorders and incident migraine headaches in this population-based prospective study.

From the Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine (Dr Swartz), and the Departments of Epidemiology (Dr Armenian) and Mental Hygiene (Ms Lee and Dr Eaton), Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md; and the Office of Analysis, Epidemiology and Health Promotion, National Center for Health Statistics, Hyattsville, Md (Dr Pratt).

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