The impact of remission and coexisting migraine on anxiety and depression in cluster headache

Byung Su Kim, Pil Wook Chung, Byung Kun Kim, Mi Ji Lee, Jeong Wook Park, Min Kyung Chu, Jin Young Ahn, Dae Woong Bae, Tae Jin Song, Jong Hee Sohn, Kyungmi Oh, Daeyoung Kim, Jae Moon Kim, Soo Kyoung Kim, Yun Ju Choi, Jae Myun Chung, Heui Soo Moon, Chin Sang Chung, Kwang Yeol Park, Soo Jin Cho

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14 Scopus citations


Background: Our aim was to investigate the relationship between coexisting cluster headache (CH) and migraine with anxiety and depression during active cluster bouts, and how symptoms change during remission. Methods: We analyzed data from 222 consecutive CH patients and 99 age- and sex-matched controls using a prospective multicenter registry. Anxiety or depression was evaluated using the Generalized Anxiety Disorder-7 (GAD-7) or Patient Health Questionnaire-9 (PHQ-9), respectively. Moderate-to-severe anxiety or depression was defined as a score of ≥10 at baseline (during a cluster bout). We assessed for changes in anxiety and depression during CH remission periods. Results: Among the CH patients, the prevalence of moderate-to-severe anxiety and depression was seen in 38.2% and 34.6%, respectively. Compared with controls, CH patients were associated with moderate-to-severe anxiety and depression (multivariable-adjusted odds ratio [aOR] = 7.32, 95% confidence intervals [CI] = 3.35-15.99 and aOR = 4.95, 95% CI = 2.32-10.57, respectively). CH patients with migraine were significantly more likely to have moderate-to-severe anxiety and depression (aOR = 32.53, 95% CI = 6.63-159.64 and aOR = 16.88, 95% CI = 4.16-68.38, respectively), compared to controls without migraine. The GAD-7 and PHQ-9 scores were significantly reduced between cluster bout and remission periods (from 6.8 ± 5.6 to 1.6 ± 2.8; P < 0.001, and from 6.1 ± 5.0 to 1.8 ± 2.4; P < 0.001, respectively). Conclusions: Our results indicate that CH patients are at increased risk of anxiety and depression, especially in the presence of coexisting migraine. However, the anxiety and depression can improve during remission periods.

Original languageEnglish
Article number58
JournalJournal of Headache and Pain
Issue number1
StatePublished - 29 May 2020

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© 2020 The Author(s).


  • Anxiety
  • Cluster headache
  • Depression
  • Headache
  • Migraine


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