Mental Health
The association between migraine and postpartum depression in Nurses’ Health Study 3: a prospective cohort study Holly Crowe* Holly Crowe Kathryn Rexrode Hadine Joffe Brittany Charlton Janet Rich-Edwards
Migraine and depression are frequently comorbid, but rarely studied longitudinally. Individuals with pre-pregnancy migraine may be more hormonally sensitive than non-migraineurs and therefore at greater risk of postpartum depression (PPD). We examined the association between physician-diagnosed migraine and PPD among participants in the Nurses’ Health Study 3 (NHS3, n=7,618 pregnancies among 5,387 individuals) between 2010 and 2023. At enrollment, NHS3 participants report if they have ever been diagnosed with migraine. Participants provide detailed pregnancy data including prospectively throughout follow-up. Participants who report a pregnancy on a biannual questionnaire receive an additional questionnaire at ~5 weeks postpartum. We ascertained PPD using the Edinburgh Postnatal Depression Scale (EPDS), a validated self-report screening tool. In separate models, we defined the outcome as an EPDS score of ≥11 (to maximize sensitivity), an EPDS score of ≥13 (to maximize specificity) and self-reported physician-diagnosis of PPD. We used log-binomial regression, accounting for non-independence of repeated pregnancies within individuals, to examine the association between migraine and PPD, adjusting for age and race/ethnicity. Overall, 26% of participants reported a history of migraine and 18% reported PPD using an EPSD cutoff of 11, while 8% reported PPD with a cutoff of 13.). Only 4% of participants reported a physician diagnosis of PPD. We found no appreciable association between pre-pregnancy migraine and PPD using an EPDS cutoff of 11 [risk ratio (RR)=1.02, 95% confidence interval (CI): 0.89–1.16) or 13 (RR=0.90, 95% CI: 0.74–1.08). Findings indicate that migraineurs may be slightly less likely to receive a PPD diagnosis (RR=0.79, 95% CI: 0.61–1.02). While depression symptom levels and antidepressant use before, after, and during pregnancy were similar among migraineurs and non-migraineurs, migraineurs were slightly less likely to report a PPD diagnosis.