Chronic headaches, particularly migraines and those that are disabling, in conjunction with severe somatic symptoms –physical symptoms of a psychological origin rather than a physical source– greatly increase the risk of major depressive disorder in women, according to a report in the medical journal Neurology.

“The literature on chronic headaches and depression is fairly robust. A number of studies have shown that headache patients are predisposed to depression,” lead author Dr. Gretchen E. Tietjen, from the University of Toledo-Health Science Campus in Ohio, told news agencies. “The novelty of our study was the inclusion of somatic symptoms, which was only previously investigated in one small study.”

The results suggest that “chronic headache, disabling headache, and severe somatic symptoms work synergistically to increase the risk of depression,” Tietjen said. Alone, the presence of chronic headache had little effect on the risk of depression compared with the effect of the combination of mild episodic headaches and minimal somatic symptoms. When the headaches become more disabling and the somatic symptoms more severe, however, the risk of depression increased markedly.

These findings are from a study of more than 1,000 women who were seen at outpatient headache centers between June 2003 and December 2004. The subjects included 593 with episodic headaches and 439 with chronic headaches. Ninety-six percent of patients with episodic headaches and 87% with chronic headaches had migraines.