Our aim was to institute a multidisciplinary quality improvement project for treatment and screening of psychiatric comorbidities in a large military and civilian population.

The prevalence of psychiatric comorbidities in patients with migraine is highly recognized.  However, the relationship between migraine and depression is not well defined.  Our quality improvement project sought to enhance screening for depression and improve access to psychiatric care in this population.

All patients presenting to a military referral center for migraines are assessed for polypharmacy, Headache Impact Score (HIT-6) and PHQ-9 Patient Depression Questionnaire.  Patients are concurrently offered referral to mental health, biofeedback therapy and a headache education course.

237 patients were seen for headache or migraine.  180 patients had severely disabling headaches. These patients accounted for 146 emergency room visits over the course of one year.  Of migraine patients, 64% had a PHQ-9 score suggesting mild, moderate or severe depression.  14% of patients had scores consistent with severe depression.  Despite 64% of patients meeting criteria for depression, only 37% carried a formal diagnosis and only 38% had been seen by mental health.  Of patients with a diagnosis of severe depression, 69% had a diagnosis and 64% were engaged with mental health.   Depression severity did not correlate with migraine severity.

Our quality improvement project demonstrates a high rate of comorbid depression among migraine patients in the military population, which did not correlated with pain severity.  It highlights the practice gap in screening for psychiatric comorbidities and the underutilization of mental health services in this population.  We hypothesize that a multidisciplinary approach to care will increase detection of comorbid depression and improve quality of life in migraine patients.