Identify the diagnosis of anxiety, depression, perceived stress in pregnant patients with headache referred to the tertiary headache clinic at the University of Washington.

Typically, women with migraine improve during pregnancy. However, this trend is less certain for patients with chronic migraine. We wanted to identify if women whose migraine headaches worsened during pregnancy were more likely to have psychiatric comorbidity.

All new patients referred to our headache clinic complete a detailed patient intake questionnaire prior to their first visit.  Our database has questions regarding current pregnancy, headache characteristics, depression and anxiety symptoms and perceived stress. All patient data are analyzed by headache providers, who collected information about previous diagnoses and treatments, and diagnose headache disorders using the ICHD-3 criteria.

Of the patients who were seen at the headache clinic, 38 were pregnant and 37 patients had migraine. Of those, 29 had chronic migraine, and 22 were identified with medication overuse headache. 20 patients (52%) had comorbid anxiety or depression, 17 (44%) had anxiety and 14 (36%) patients had depression, 4 patients had post-traumatic stress disorder and 2 had bipolar disorder. In 31(81%),the patients’ headache had a major impact on their work.

Our results show high incidence of psychiatric comorbidities in pregnant women presenting to the headache clinic. Migraine is common in women of reproductive age, and hormonal fluctuations in connection with pregnancy can influence attack frequency. Previous studies, including analyses of patient data at our headache clinic, suggest that psychiatric comorbidities are more common in chronic migraine.  These mechanisms may explain the high prevalence of chronic migraine as well as psychiatric comorbidity in this group.  These patients warrant a greater degree of attention in headache clinic, as they may have more severe health issues while having limited treatment options due to pregnancy.