TOPLINE: 

Patients with migraine had a higher risk of developing depression or anxiety than individuals without migraine, and this elevated risk persisted after accounting for shared genetic factors and childhood family environments; however, small area deprivation did not significantly modify the association.

METHODOLOGY:

• Researchers conducted a nationwide cohort study to assess whether individuals with migraine had an increased risk of developing depression or anxiety and whether this association was affected by small area deprivation.
• They used data from linked registers and included 4,065,375 individuals aged 10-50 years in Sweden (2015-2023) who had no history of depression or anxiety in the 10 years prior to study initiation. Of these individuals, 197,346 had migraine (median age, 30 years; 73.2% women).
• Researchers generated a matched cohort by randomly matching each individual with migraine exposure to 10 unexposed individuals based on sex and 5-year age groups (n = 1,455,352) and established a sibling cohort of full siblings discordant for migraine exposure (n = 179,888).
• Migraine exposure was defined using the date of the first diagnosis in primary, specialist outpatient, or inpatient care. If no diagnosis was recorded, migraine exposure was defined using the date of the first dispensed migraine‑specific prescription.
• The outcome was depression or anxiety, defined using the date of the first diagnosis in primary, specialist outpatient, or inpatient care. If no diagnosis was recorded, the outcome was defined using the date of the first dispensed prescription for treatment.

TAKEAWAY:

• In the matched cohort, during 7,214,949 person-years of follow-up, the incidence of depression or anxiety was higher in patients with migraine than in individuals without migraine (39.2 vs 21.9 episodes per 1000 person-years), with a 78% higher risk in the migraine group (P < .001).
• In the sibling cohort, during 862,613 person-years of follow-up, siblings with migraine had a higher incidence of depression or anxiety than those without migraine (37.7 vs 20.3 per 1000 person-years), and the risk was 63% higher in the migraine group (P < .001).
• Among patients with migraine, small area deprivation did not modify the risk of developing depression or anxiety in either the matched or sibling cohort.

IN PRACTICE:

"These results suggest a more complicated role for small area deprivation in the development of these conditions and potentially in terms of modifying any potential bidirectional relationship," the authors wrote.

"Further research is needed to better elucidate to what extent, if any, social and environmental conditions may modify how these conditions relate to one another," they added.

SOURCE:

The study was led by Emily White Johansson, Karolinska Institutet, Stockholm, Sweden. It was published online on February 23, 2026, in The Journal of Headache and Pain.

LIMITATIONS:

Data on the exposure and outcome were obtained from administrative registers, which may have underreported or misclassified cases of migraine, depression, and anxiety. Regional primary care registers included data from only 17 of 21 regions and were limited to the years 2015-2017, potentially underestimating the prevalence of all three conditions and affecting the observed associations. The observational nature of the study may have introduced residual confounding and limited causal interference.

DISCLOSURES:

This study was sponsored by Pfizer. One author declared receiving honoraria from various pharmaceutical companies and being a coinventor on a patent related to a biofeedback intervention for migraine prophylaxis. Two authors declared being employees of and holding stock in Pfizer.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.