BMJ Open 3:e002057 doi:10.1136/bmjopen-2012-002057
  • Mental health
    • Research

The contribution of stress to the comorbidity of migraine and major depression: results from a prospective cohort study

  1. Ian Colman2,3
  1. 1Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
  3. 3Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to: Dr Ian Colman; icolman{at}
  • Received 3 September 2012
  • Revised 30 January 2013
  • Accepted 8 February 2013
  • Published 9 March 2013


Objectives To assess how much the association between migraine and depression may be explained by various measures of stress.

Design National Population Health Survey is a prospective cohort study representative of the Canadian population. Eight years of follow-up time were used in the present analyses.

Setting Canadian adult population ages 18–64.

Participants 9288 participants.

Outcome Incident migraine and major depression.

Results Adjusting for sex and age, depression was predictive of incident migraine (HR: 1.62; 95% CI 1.03 to 2.53) and migraine was predictive of incident depression (HR: 1.55; 95% CI 1.15 to 2.08). However, adjusting for each assessed stressor (childhood trauma, recent marital problems, recent unemployment, recent household financial problems, work stress, chronic stress and change in social support) decreased this association, with chronic stress being a particularly strong predictor of outcomes. When adjusting for all stressors simultaneously, both associations were largely attenuated (depression–migraine HR: 1.30; 95% CI 0.80 to 2.10; migraine–depression HR: 1.19; 95% CI 0.86 to 1.66).

Conclusions Much of the apparent association between migraine and depression may be explained by stress.

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