Headache Frequency, Medication Overuse, and Depression Linked to Migraine

woman with headache
woman with headache
Researchers found that medication overuse is linked to migraines.

Increased headache day frequency, acute medication overuse and/or high-frequency use, and depression were the most strongly identified risk factors identified for the new onset of chronic migraine (CM)/transformed migraine (TM), chronic daily headache (CDH), or related chronic headache diseases, according to research published in Headache.

Through a PubMed database search, investigators identified 13 longitudinal cohort studies and 4 case-controlled studies on the risk factors associated with the new onset of CM/TM, CDH, or related diagnoses from English language literature published before March 2018. The analysis included the methodology, analytic criteria, strength of evidence, and results for each manuscript and for the parent study. Researchers identified risk factors as nonmodifiable, modifiable, and based on putative mechanisms, and organized them as follows

  • comorbid and concomitant diseases and conditions,
  • headache features,
  • lifestyle factors and habits, 
  • pharmacologic treatment-related, and
  • sociodemographics.

The review included theories of pathophysiology underlying the development of new onset chronic migraine or increasing attack frequency.

Headache frequency in headache days per month was reported as a significant risk factor in new onset of CM. Studies reported data showing that higher frequency of episodic migraine was associated with progression to CM. Depression was found to be a significant predictor of CM onset (odds ratio [OR]=1.7; 1.1-2.5) with increased risk with depression severity. Adolescents with depression were identified as being at higher risk for CDH. Use of medications containing barbiturates (OR=2.1; 1.3-3.1) or opioids (OR=1.2; 1.4-2.2) increased the risk of CM onset over the following year, with a linear relationship of increased days of medication use to increased odds of CM onset.

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This study is limited by evolving case definitions of CM, TM, and CDH in the analysis of data across studies. The researchers from this study suggested that modifiable risk factors may provide potential targets for intervention, including patient education as well as active treatment modification.

One author declares associations with the pharmaceutical industry. Please see original reference for author’s disclosures.


Buse DC, Greisman JD, Baigi K, Lipton RB. Migraine progression: a systematic review [published online December 27, 2018]. Headache. doi:10.1111/head.13459