Intensity of depression, its predictive and mediating factors in the patients with chronic headache

Headache is often associated with depression. However, depressive symptoms are more severe in some patients. The aim of the present study was to compare different types of chronic headache in regard to severity, frequency, depression, disability and physical and psychological impairment. We also examined the predictive and mediating factors of depression in the patients with chronic headache.
This cross-sectional study included 203 patients with different types of chronic headache. For assessment of depression and pain intensity we used Patient Health Questionnaire (PHQ-9) and Numeric Rating Scale (NRS) respectively. For evaluation of disability we used physical and psychological impairment, and Migraine Disability Assessment (MIDAS).
Patients with different types of chronic headache revealed no significant differences regarding pain intensity, disability, and subjective physical and psychological impairment. Migraine patients showed the least pain frequency compared to the patients with other types of headache. Patients with migraine had lower severity of depressive symptoms compared to the patients suffering from cluster or mixed chronic headache. 41% of the changes in the scores, based on linear model of depression were predictable by pain diagnosis and disability rate. The results of multiple mediation showed the mediating role of the severity of disability in the relationship between pain intensity and depression.
The patient's pain intensity could result in depression through causing disability in doing personal and social activities.