Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-25T08:21:21.054Z Has data issue: false hasContentIssue false
  • English
  • Français

The Comorbidity of Migraine

Published online by Cambridge University Press:  07 November 2014

Nancy C.P. Low  and
Kathleen Ries Merikangas
Get access Rights & Permissions [Opens in a new window]

Abstract

This review addresses the methodologic issues relevant to the study of comorbidity and provides a broad overview of the medical and psychiatric conditions associated with migraine. Since the body of literature examining the comorbidity of migraine is enormous, the scope of this review will largely focus on community and case-control studies. Among the selected comorbid medical conditions, including disorders of the cardiovascular, respiratory, neurologic, gastrointestinal and immunologic systems, stroke, asthma, and allergies appear to be most strongly associated with migraine. Among the psychiatric illnesses, mood and anxiety disorders have been shown to be most strongly associated with migraine in the general population. Further research is indicated and necessary to elucidate the precise mechanism of migraine comorbidity.

Type
Review
Information
CNS Spectrums , Volume 8 , Issue 6: Migraines: Neurological and Psychiatric Perspectives , June 2003 , pp. 433 - 444
Copyright
Copyright © Cambridge University Press 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Feinstein, A. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis. 1970;23:455–468.CrossRefGoogle ScholarPubMed
2.Kaplan, MH, Feinstein, AR. The importance of classifying initial co-morbidity in evaluation the outcome of diabetes mellitus. J Chronic Dis. 1974;27:387–404.CrossRefGoogle ScholarPubMed
3.Pfohl, B, Stangl, D, Zimmerman, M. The implications of DSM-III personality disorders for patients with major depression. J Affect Disord. 1984;7:309–318.CrossRefGoogle ScholarPubMed
4.Winokur, G, Black, DW, Nasrallah, A. Depressions secondary to other psychiatric disorders and medical illnesses. Am J Psychiatry. 1988;145:233–237.Google ScholarPubMed
5.Black, DW, Winokur, G, Nasrallah, A. Is death from natural causes still excessive in psychiatric patients? A follow-up of 1593 patients with major affective disorder. J Nerv Ment Dis. 1987;175:674–680.CrossRefGoogle ScholarPubMed
6.Berkson, J. Limitation of the application of the 4-fold table analysis to hospital data. Biometrics. 1946;2:47–53.CrossRefGoogle Scholar
7.Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia. 1988;8(suppl 7):1–96.Google Scholar
8.Waters, WE. Headache and blood pressure in the community. Br Med J. 1971;1:142–143.CrossRefGoogle ScholarPubMed
9.Schele, R, Ahlborg, B, Ekbom, K. Physical characteristics and allergic history in young men with migraine and other headaches. Headache. 1978;18:80–86.CrossRefGoogle ScholarPubMed
10.Chen, TC, Leviton, A, Edelstein, S, Ellenberg, JH. Migraine and other diseases in women of reproductive age. The influence of smoking on observed associations. Arch Neurol. 1987;44:1024–1028.CrossRefGoogle ScholarPubMed
11.Weiss, NS. Relation of high blood pressure to headache, epistaxis, and selected other symptoms. The United States Health Examination Survey of Adults. N Engl J Med. 1972;287:631–633.CrossRefGoogle ScholarPubMed
12.Rasmussen, BK, Olesen, J. Symptomatic and nonsymptomatic headaches in a general population. Neurology. 1992;42:1225–1231.CrossRefGoogle ScholarPubMed
13.Hagen, K, Stovner, LJ, Vatten, L, Holmen, J, Zwart, JA, Bovim, G. Blood pressure and risk of headache: a prospective study of 22,685 adults in Norway. J Neurol Neurosurg Psychiatry. 2002;72:463–466.Google Scholar
14.Gardner, J, Mountain, G, Hinew, E. The relationship of migraine to hypertension and to hypertensive headaches. Am J Med Sci. 1940;22:50–53.CrossRefGoogle Scholar
15.Walker, C. Migraine and its relationship to hypertension. Br Med J. 1959:1430–1431.CrossRefGoogle ScholarPubMed
16.Featherstone, HJ. Medical diagnoses and problems in individuals with recurrent idiopathic headaches. Headache. 1985;25:136–140.CrossRefGoogle ScholarPubMed
17.Markush, RE, Karp, HR, Heyman, A, O'Fallon, WM. Epidemiologic study of migraine symptoms in young women. Neurology. 1975;25:430–435.CrossRefGoogle ScholarPubMed
18.Leviton, A, Malvea, B, Graham, JR. Vascular diseases, mortality, and migraine in the parents of migraine patients. Neurology. 1974;24:669–672.CrossRefGoogle ScholarPubMed
19.Couch, JR, Hassanein, RS. Headache as a risk factor in atherosclerosis-related diseases. Headache. 1989;29:49–54.CrossRefGoogle ScholarPubMed
20.Gamberini, G, D'Alessandro, R, Labriola, E, et al.Further evidence on the association of mitral valve prolapse and migraine. Headache. 1984;24:39–40.CrossRefGoogle ScholarPubMed
21.Featherstone, HJ. Clinical features of stroke in migraine: a review. Headache. 1986;26:128–133.CrossRefGoogle ScholarPubMed
22.Curtis, KM, Chrisman, CE, Peterson, HB. Contraception for women in selected circumstances. Obstet Gynecol. 2002;99:1100–1112.Google ScholarPubMed
23.Cook, NR, Bensenor, IM, Lotufo, PA, et al.Migraine and coronary heart disease in women and men. Headache. 2002;42:715–727.CrossRefGoogle ScholarPubMed
24.Buring, JE, Hennekens, C, the Women's Health Study Research Group. The Women's Health Study: rationale, background and summary of the study design. Journal of Myocardial Ischemia. 1992;4:27–40.Google Scholar
25.Rexode, KM, Lee, IM, Cook, N, Hennekens, C, Buring, JE. Baseline characteristics of participants in the Women's Health Study. J Womens Health Gend Based Med. 2000;9:19–27.CrossRefGoogle Scholar
26.Manson, J, Buring, JE, Statterfield, D, Hennekens, C. Baseline characteristics of participants in the Physicians' Health Study: a randomized trial of aspirin and beta-carotene in U.S. physicians. Am J Prev Med. 1991;7:150–154.CrossRefGoogle ScholarPubMed
27.Findings from the aspirin component of the ongoing Physicians' Health Study. N Engl J Med. 1988;318:262–264.CrossRefGoogle Scholar
28.Galiano, L, Matias-Guiu, J, Vioque, J, Falip, R, Martin, R, Oltra, A. A case-control study of the associated factors with migraine. Cephalalgia. 1993;13(suppl 13):9.Google Scholar
29.Stang, PE, Yanagihara, PA, Swanson, JW, et al.Incidence of migraine headache: a population-based study in Olmsted County, Minnesota. Neurology. 1992;42:1657–1662.CrossRefGoogle ScholarPubMed
30.Buring, JE, Hebert, P, Romero, J, et al.Migraine and subsequent risk of stroke in the Physicians' Health Study. Arch Neurol. 1995;52:129–134.CrossRefGoogle ScholarPubMed
31.Merikangas, KR, Fenton, BT, Cheng, SH, Stolar, MJ, Risch, N. Association between migraine and stroke in a large-scale epidemiological study of the United States. Arch Neurol. 1997;54:362–368.CrossRefGoogle Scholar
32.Final report on the aspirin component of the ongoing Physicians' Health Study. Steering Committee of the Physicians' Health Study Research Group. N Engl J Med. 1989;321:129–135.CrossRefGoogle Scholar
33.Welch, KM, Levine, SR. Migraine-related stroke in the context of the International Headache Society classification of head pain. Arch Neurol. 1990;47:458–462.CrossRefGoogle ScholarPubMed
34.Oral contraceptives and stroke in young women: associated risk factors. JAMA. 1975;231:718–722.CrossRefGoogle Scholar
35.Henrich, JB, Horwitz, RI. A controlled study of ischemic stroke risk in migraine patients. J Clin Epidemiol. 1989;42:773–780.CrossRefGoogle ScholarPubMed
36.Tzourio, C, Iglesias, S, Hubert, JB, et al.Migraine and risk of ischaemic stroke: a case-control study. Br Med J. 1993;307:289–292.CrossRefGoogle ScholarPubMed
37.Tzourio, C, Tehindrazanarivelo, A, Iglesias, S, et al.Case-control study of migraine and risk of ischaemic stroke in young women. Br Med J. 1995;310:830–833.CrossRefGoogle ScholarPubMed
38.Carolei, A, Marini, C, De Matteis, G. History of migraine and risk of cerebral ischaemia in young adults. The Italian National Research Council Study Group on Stroke in the Young. Lancet. 1996;347:1503–1506.CrossRefGoogle Scholar
39.Chang, CL, Donaghy, M, Poulter, N. Migraine and stroke in young women: case-control study. The World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Br Med J. 1999;318:13–18.CrossRefGoogle ScholarPubMed
40.Paskind, H. Relationship of migraine, epilepsy and some other neuropsychiatric disorders. Arch Neurol Psychiatr. 1934;32:45–50.CrossRefGoogle Scholar
41.Barolin, C. Migraine and epilepsy. Brain. 1966;7:53–66.Google Scholar
42.Basser, LS. The relation of migraine and epilepsy. Brain. 1969;92:285–300.CrossRefGoogle ScholarPubMed
43.Andermann, E, Andermann, F. Clinical features of migraine-epilepsy syndromes. In: Lugaresi, E, ed. Migraine and Epilepsy. Boston, Mass: Butterworths; 1987:3–30.Google ScholarPubMed
44.Andermann, E, Andermann, F. Migraine-epilepsy relationships: epidemiological and genetic aspects. In: Lugaresi, E, ed. Migraine and Epilepsy. Boston, Mass: Butterworths; 1987:281–291.Google ScholarPubMed
45.Lennox, W, Lennox, M. Epilepsy and Related Disorders. vol 1. Boston, Mass: Little, Brown and Co.; 1960.Google Scholar
46.Dalsgaard-Nielson, A. Migraene og epilepsi. Ugesdkr Laeger. 1964;126:185–191.Google Scholar
47.Lance, J, Anthony, M. Some clinical aspects of migraine. Arch Neurol. 1966;15:356–361.CrossRefGoogle ScholarPubMed
48.Matias-Guiu, J, Galiano, L, Vioque, J, Falip, R, Martin, R. A case-control study to evaluate the association of epilepsy and migraine. Neuroepidemiology. 1992;11:313–314.CrossRefGoogle ScholarPubMed
49.Ely, FA. Migraine-epilepsy syndrome: statistical study of heredity. Arch Neurol Psychiatry. 1930;24:943–949.CrossRefGoogle Scholar
50.Bille, B. Migraine in school children. Acta Paediatr Scand. 1962;51(suppl 136):3–151.CrossRefGoogle Scholar
51.Ottman, R, Lipton, RB. Comorbidity of migraine and epilepsy. Neurology. 1994;44:2105–2110.CrossRefGoogle ScholarPubMed
52.Kraus, D. Migraine and Epilepsy: A Case for Divorce [master's thesis]. Montreal, Canada: Graduate studies and research, McGill; 1978.Google Scholar
53.Bladin, PF. The association of benign rolandi epilepsy with migraine. In: Lugaresi, E, ed. Migraine and Epilepsy. Boston, Mass: Butterworths; 1987:281–291.Google Scholar
54.Kinast, M, Lueders, H, Rothner, A, Erenberg, G. Benign epileptiform discharges in childhood migraine. Neurology. 1982;32:1309–1311.CrossRefGoogle ScholarPubMed
55.Septien, L, Pelletier, JL, Brunotte, F, Giroud, M, Dumas, R. Migraine in patients with history of centro-temporal epilepsy in childhood: a Hm-PAO SPECT study. Cephalalgia. 1991;11:281–284.CrossRefGoogle ScholarPubMed
56.Santucci, M, Giovanardi Rossi, P, Ambrosetto, G, Sacquegna, T, D'Alessandro, R. Migraine and benign epilepsy with rolandic spikes in childhood: a case-control study. Dev Med Child Neurol. 1985;27:60–62.CrossRefGoogle ScholarPubMed
57.Baier, WK, Doose, H. Migraine and petit mal absence: familial prevalence of migraine and seizures. In: Lugaresi, E, ed. Migraine and Epilepsy. Boston, Mass: Butterworths; 1987:293–311.Google Scholar
58.Strachan, DP, Butland, BK, Anderson, HR. Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort. Br Med J. 1996;312:1195–1199.CrossRefGoogle Scholar
59.Von Behren, J, Kreutzer, R, Hernandez, A. Self-reported asthma prevalence in adults in California. J Asthma. 2002;39:429–440.CrossRefGoogle ScholarPubMed
60.Chen, TC, Leviton, A. Asthma and eczema in children born to women with migraine. Arch Neurol. 1990;47:1227–1230.CrossRefGoogle ScholarPubMed
61.Mediana, JL, Diamond, S. Migraine and atopy. Headache. 1976;15:271–273.CrossRefGoogle ScholarPubMed
62.Monro, J, Brostoff, J, Carini, C, Zilkha, K. Food allergy in migraine. Study of dietary exclusion and RAST. Lancet. 1980;2:1–4.CrossRefGoogle ScholarPubMed
63.Speight, JW, Atkinson, P. Food allergy in migraine. Lancet. 1980;2:532.CrossRefGoogle ScholarPubMed
64.Mortimer, MJ, Kay, J, Jaron, A. Clinical epidemiology of childhood abdominal migraine in an urban general practice. Dev Med Child Neurol. 1993;35:243–248.CrossRefGoogle Scholar
65.Mortimer, MJ, Kay, J, Gawkrodger, DJ, Jaron, A, Barker, DC. The prevalence of headache and migraine in atopic children: an epidemiological study in general practice. Headache. 1993;33:427–431.CrossRefGoogle ScholarPubMed
66.Davey, G, Sedgwick, P, Maier, W, Visick, G, Strachan, DP, Anderson, HR. Association between migraine and asthma: matched case-control study. Br J Gen Pract. 2002;52:723–727.Google ScholarPubMed
67.Abu-Arafeh, IA, Russell, G. Current controversies—abdominal migraine. Cephalalgia. 1993;13:138–139.CrossRefGoogle ScholarPubMed
68.Apley, J, Naish, N. Recurrent abdominal pains: a field survey of 1000 school children. Arch Dis Child. 1958;33:165–170.CrossRefGoogle Scholar
69.Pringle, MLK, Butler, NR, Davie, R. 11,000 Seven-Year-Olds. London, England: Longman; 1966.Google Scholar
70.Miller, FJW, Court, SDM, Knox, EG. The School Years in Newcastle upon Tyne. London, England: Oxford University Press; 1974.Google Scholar
71.Anttila, P, Metsahonkala, L, Mikkelsson, M, Helenius, H, Sillanpaa, M. Comorbidity of other pains in schoolchildren with migraine or nonmigrainous headache. J Pediatr. 2001;138:176–180.CrossRefGoogle ScholarPubMed
72.Gasbarrini, A, Gabrielli, M, Fiore, G, et al.Association between Helicobacter pylori cytotoxic type I CagA-positive strains and migraine with aura. Cephalalgia. 2000;20:561–565.CrossRefGoogle ScholarPubMed
73.Rounsaville, BJ, Dolinsky, ZS, Babor, TF, Meyer, RE. Psychopathology as a predictor of treatment outcome in alcoholics. Arch Gen Psychiatry. 1987;44:505–513.CrossRefGoogle ScholarPubMed
74.Fulop, G, Strain, JJ, Vita, J, Lyons, JS, Hammer, JS. Impact of psychiatric comorbidity on length of hospital stay for medical/surgical patients: a preliminary report. Am J Psychiatry. 1987;144:878–882.Google ScholarPubMed
75.Breslau, N. Migraine, suicidal ideation, and suicide attempts. Neurology. 1992;42:392–395.CrossRefGoogle ScholarPubMed
76.Brewerton, TD, George, MS, Harden, RN. Migraine and the eating disorders. Psychiatry Res. 1993;46:201–202.CrossRefGoogle ScholarPubMed
77.George, MS, Brewerton, TD, Harden, RN. Bulimia nervosa in outpatients with migraine: a pilot study. J Nerv Ment Dis. 1993;181:704–706.CrossRefGoogle ScholarPubMed
78.Fasmer, OB. The prevalence of migraine in patients with bipolar and unipolar affective disorders. Cephalalgia. 2001;21:894–899.CrossRefGoogle ScholarPubMed
79.Kudrow, L, Sutkus, BJ. MMPI pattern specificity in primary headache disorders. Headache. 1979;19:18–24.CrossRefGoogle ScholarPubMed
80.Lainez, MJ, Monzon, MJ. Chronic daily headache. Curr Neurol Neurosci Rep. 2001;1:118–124.CrossRefGoogle ScholarPubMed
81.Merikangas, KR, Merikangas, JR, Angst, J. Headache syndromes and psychiatric disorders: association and familial transmission. J Psychiatr Res. 1993;27:197–210.CrossRefGoogle ScholarPubMed
82.Marazziti, D, Toni, C, Pedri, S, et al.Prevalence of headache syndromes in panic disorder. Int Clin Psychopharmacol. 1999;14:247–251.CrossRefGoogle ScholarPubMed
83.Marazziti, D, Toni, C, Pedri, S, et al.Headache, panic disorder and depression: comorbidity or a spectrum? Neuropsychobiology. 1995;31:125–129.CrossRefGoogle ScholarPubMed
84.Mitsikostas, DD, Thomas, AM. Comorbidity of headache and depressive disorders. Cephalalgia. 1999;19:211–217.CrossRefGoogle ScholarPubMed
85.Moldin, SO, Scheftner, WA, Rice, JP, Nelson, E, Knesevich, MA, Akiskal, H. Association between major depressive disorder and physical illness. Psychol Med. 1993;23:755–761.CrossRefGoogle ScholarPubMed
86.Radat, F, Sakh, D, Lutz, G, el Amrani, M, Ferreri, M, Bousser, MG. Psychiatric comorbidity is related to headache induced by chronic substance use in migraineurs. Headache. 1999;39:477–480.CrossRefGoogle ScholarPubMed
87.Juang, KD, Wang, SJ, Fuh, JL, Lu, SR, Su, TP. Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes. Headache. Nov-2000;40:818–823.CrossRefGoogle ScholarPubMed
88.Terwindt, GM, Ferrari, MD, Tijhuis, M, Groenen, SM, Picavet, HS, Launer, LJ. The impact of migraine on quality of life in the general population: the GEM study. Neurology. 2000;55:624–629.CrossRefGoogle ScholarPubMed
89.Verri, AP, Proietti Cecchini, A, Galli, C, Granella, F, Sandrini, G, Nappi, G. Psychiatric comorbidity in chronic daily headache. Cephalalgia. 1998;18(suppl 21):45–49.CrossRefGoogle ScholarPubMed
90.Weeks, R, Baskin, S, Sheftell, F, Rapoport, A, Arrowsmith, F. A comparison of MMPI personality data and frontalis electromyographic readings in two groups of daily headache sufferers. Headache. 1983;23:83–85.CrossRefGoogle ScholarPubMed
91.Breslau, N, Davis, GC. Migraine, physical health and psychiatric disorder: a prospective epidemiologic study in young adults. J Psychiatr Res. 1993;27:211–221.CrossRefGoogle ScholarPubMed
92.Breslau, N, Davis, GC, Schultz, LR, Peterson, EL. Joint 1994 Wolff Award Presentation. Migraine and major depression: a longitudinal study. Headache. 1994;34:387–393.CrossRefGoogle ScholarPubMed
93.Breslau, N, Schultz, LR, Stewart, WF, Lipton, RB, Lucia, VC, Welch, KM. Headache and major depression: is the association specific to migraine? Neurology. 2000;54:308–313.CrossRefGoogle ScholarPubMed
94.Swartz, KL, Pratt, LA, Armenian, HK, Lee, LC, Eaton, WW. Mental disorders and the incidence of migraine headaches in a community sample: results from the Baltimore Epidemiologic Catchment area follow-up study. Arch Gen Psychiatry. 2000;57:945–950.CrossRefGoogle Scholar
95.Merikangas, KR, Angst, J, Isler, H. Migraine and Psychopathology. Arch Gen Psychiatry. 1990;47:849–853.CrossRefGoogle ScholarPubMed
96.Bland, RC. Epidemiology of affective disorders: a review. Can J Psychiatry. 1997;42:367–377.CrossRefGoogle ScholarPubMed
97.Ferrari, MD. Migraine. Lancet. 1998;351:1043–1051.CrossRefGoogle ScholarPubMed
98.Crisp, AH, Kalucy, RS, McGuinness, B, Ralph, PC, Harris, G. Some clinical, social and psychological characteristics of migraine subjects in the general population. Postgrad Med J. 1977;53:691–697.CrossRefGoogle ScholarPubMed
99.Paulin, JM, Waal-Manning, HJ, Simpson, FO, Knight, RG. The prevalence of headache in a small New Zealand town. Headache. 1985;25:147–151.CrossRefGoogle Scholar
100.Breslau, N. Psychiatric comorbidity in migraine. Cephalalgia. 1998;18(suppl 22):56–58; discussion 58-61.CrossRefGoogle ScholarPubMed
101.Breslau, N, Schultz, LR, Stewart, WF, Lipton, R, Welch, KM. Headache types and panic disorder: directionality and specificity. Neurology. 2001;56:350–354.CrossRefGoogle ScholarPubMed
102.Selby, G, Lance, J. Observations on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiatry. 1960;23:23–32.CrossRefGoogle ScholarPubMed
103.Kashiwagi, T, McClure, JN Jr., Wetzel, RD. Headache and psychiatric disorders. Dis Nerv Syst. 1972;33:659–663.Google ScholarPubMed
104.Morrison, DP, Price, WH. The prevalence of psychiatric disorder among female new referrals to a migraine clinic. Psychol Med. 1989;19:919–925.CrossRefGoogle ScholarPubMed
105.Glover, V, Sandler, M. The biochemical basis of migraine predisposition. In: Collins, GM, ed. Migraine: A Spectrum of Ideas. New York, NY: Oxford University Press; 1990:228–258.CrossRefGoogle Scholar
106.Diamond, S. Depressive Headaches. Headache. 1964;4:255–259.CrossRefGoogle ScholarPubMed
107.Philips, C, Hunter, M. Headache in a psychiatric population. J Nerv Ment Dis. 1982;170:34–40.CrossRefGoogle Scholar
108.Garvey, MJ, Tollefson, GD, Schaffer, CB. Migraine headaches and depression. Am J Psychiatry. 1984;141:986–988.Google ScholarPubMed
109.Merikangas, KR, Risch, NJ, Merikangas, JR, Weissman, MM, Kidd, KK. Migraine and depression: association and familial transmission. J Psychiatr Res. 1988;22:119–129.CrossRefGoogle ScholarPubMed
110.Marchesi, C, De Ferri, A, Petrolini, N, et al.Prevalence of migraine and muscle tension headache in depressive disorders. J Affect Disord. 1989;16:33–36.CrossRefGoogle ScholarPubMed
111.Mahmood, T, Romans, S, Silverstone, T. Prevalence of migraine in bipolar disorder. J Affect Disord. 1999;52:239–241.CrossRefGoogle ScholarPubMed
112.Younes, RP, DeLong, GR, Neiman, G, Rosner, B. Manic-depressive illness in children: treatment with lithium carbonate. J Child Neurol. 1986;1:364–368.CrossRefGoogle ScholarPubMed
113.Cassidy, WL, Flanagan, NB. Clinical observations in manic-depressive disease. J Am Med Assoc. 1957;164:1535–1546.CrossRefGoogle ScholarPubMed
114.Blehar, MC, DePaulo, JR Jr, Gershon, ES, Reich, T, Simpson, SG, Nurnberger, JI Jr. Women with bipolar disorder: findings from the NIMH Genetics Initiative sample. Psychopharmacol Bull. 1998;34:239–243.Google ScholarPubMed
115.Robbins, L, Ludmer, C. Headache The bipolar spectrum in migraine patients. American Journal of Pain Management. 2000;10:167–170.Google Scholar
116.Akiskal, HS. The bipolar spectrum: new concepts in classification and diagnosis. In: Grinspoon, L, ed. Psychiatry Update: The American Psychiatric Association Annual Review. Washington, D.C.: American Psychiatric Press; 1983:271–292.Google Scholar
117.Akiskal, HS, Cassano, GB, Musetti, L, Perugi, G, Tundo, A, Mignani, V. Psychopathology, temperament, and past course in primary major depressions. 1. Review of evidence for a bipolar spectrum. Psychopathology. 1989;22:268–277.CrossRefGoogle ScholarPubMed
118.Akiskal, HS. Toward a temperament-based approach to depression: implications for neurobiologic research. Adv Biochem Psychopharmacol. 1995;49:99–112.Google Scholar