Migraine and psychiatric comorbidity: a review of clinical findings

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Abstract

Migraine is an extremely common disorder. The underlying mechanisms of this chronic illness interspersed with acute symptoms appear to be increasingly complex. An important aspect of migraine heterogeneity is comorbidity with other neurological diseases, cardiovascular disorders, and psychiatric illnesses. Depressive disorders are among the leading causes of disability worldwide according to WHO estimation. In this review, we have mainly considered the findings from general population studies and studies on clinical samples, in adults and children, focusing on the association between migraine and psychiatric disorders (axis I of the DSM), carried over after the first classification of IHS (1988). Though not easily comparable due to differences in methodology to reach diagnosis, general population studies generally indicate an increased risk of affective and anxiety disorders in patients with migraine, compared to non-migrainous subjects. There would also be a trend towards an association of migraine with bipolar disorder, but not with substance abuse/dependence. With respect to migraine subtypes, comorbidity mainly involves migraine with aura. Patients suffering from migraine, however, show a decreased risk of developing affective and anxiety disorders compared to patients with daily chronic headache. It would also appear that psychiatric disorders prevail in patients with chronic headache and substance use than in patients with simple migraine. The mechanisms underlying migraine psychiatric comorbidity are presently poorly understood, but this topic remains a priority for future research. Psychiatric comorbidity indeed affects migraine evolution, may lead to chronic substance use, and may change treatment strategies, eventually modifying the outcome of this important disorder.

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Most cited references 63

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Comorbidity of migraine and depression: investigating potential etiology and prognosis.

K Welch, N Breslau, Kim L Schultz … (2003)

An association between migraine and major depression has been observed in clinical and community samples. The factors that contribute to this association and their implications remain unclear. To determine the factors contributing to the association of migraine and major depression. A cohort study of persons aged 25 to 55 years with migraine (n = 496) or with other headaches of comparable severity (n = 151) and control subjects with no history of severe headaches (n = 539) randomly selected from the general community were interviewed first in 1997 and then reinterviewed in 1999. Major depression at baseline predicted the first-onset migraine during the 2-year follow-up period (odds ratio [OR] = 3.4; 95% CI = 1.4, 8.7) but not other severe headaches (OR = 0.6; 95% CI = 0.1, 4.6). Migraine at baseline predicted the first-onset major depression during follow-up (OR = 5.8; 95% CI = 2.7, 12.3); the prospective association from severe headaches to major depression was not significant (OR = 2.7; 95% CI = 0.9, 8.1). Comorbid major depression did not influence the frequency of migraine attacks, their persistence, or the progression of migraine-related disability over time. Major depression increased the risk for migraine, and migraine increased the risk for major depression. This bidirectional association, with each disorder increasing the risk for first onset of the other, was not observed in relation to other severe headaches. With respect to other severe headaches, there was no increased risk associated with pre-existing major depression, although the possibility of an influence in the reverse direction (i.e., from severe headaches to depression) cannot be securely ruled out.

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Comorbidity of migraine and psychiatric disorders--a national population-based study.

Michael W. Becker, Nathalie Jetté, Scott Patten … (2008)

Migraine is common, with an estimated lifetime prevalence of 7-17%. Population-based studies have reported an association between various psychiatric conditions and migraine. This is a population-based study exploring the association between migraine and psychiatric disorders in a large cohort and assessing various health-related outcomes. (1) Determine the prevalence of various psychiatric conditions in association with migraine; (2) describe the patterns of association of these comorbidities with a variety of health-related outcomes. Data from the 2002 Canadian Community Health Survey were used. This is a national health survey which included administration of the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects. Health-related outcomes included 2-week disability, restriction of activities, quality-of-life, and mental health care utilization. The prevalence of physician-diagnosed migraine (n=36,984) was 15.2% for females and 6.1% for males. Migraine was most common in those between ages 25 and 44 years and in those of lower income. Migraine was associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia, all occurring more than twice as often in those with migraines compared with those without. Migraine was not associated with drug, alcohol, or substance dependence. The higher prevalence of psychiatric disorders in migraineurs was not related to sociodemographic variables. Psychiatric disorders were less common in those over 65 years, in those who were in a relationship, and in those of higher income whether migraine was present or not. Health-related outcomes were worst in those with both migraines and a psychiatric disorder and intermediate in those with either condition alone. Migraine is associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia. Migraine in association with various mental health disorders results in poorer health-related outcomes compared with migraine or a psychiatric condition alone. Understanding the psychiatric correlates of migraine is important in order to adequately manage this patient population and to guide public health policies regarding health services utilization and health-care costs.

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Depression and anxiety associated with three pain conditions: results from a nationally representative sample.

Lachlan McWilliams, Mark D Goodwin, Marc Cox (2004)

Investigations of the relationship between pain conditions and psychopathology have largely focused on depression and have been limited by the use of non-representative samples (e.g. clinical samples). The present study utilized data from the Midlife Development in the United States Survey (MIDUS) to investigate associations between three pain conditions and three common psychiatric disorders in a large sample (N = 3,032) representative of adults aged 25-74 in the United States population. MIDUS participants provided reports regarding medical conditions experienced over the past year including arthritis, migraine, and back pain. Participants also completed several diagnostic-specific measures from the Composite International Diagnostic Interview-Short Form [Int. J. Methods Psychiatr. Res. 7 (1998) 171], which was based on the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association 1987]. The diagnoses included were depression, panic attacks, and generalized anxiety disorder. Logistic regression analyses revealed significant positive associations between each pain condition and the psychiatric disorders (Odds Ratios ranged from 1.48 to 3.86). The majority of these associations remained statistically significant after adjusting for demographic variables, the other pain conditions, and other medical conditions. Given the emphasis on depression in the pain literature, it was noteworthy that the associations between the pain conditions and the anxiety disorders were generally larger than those between the pain conditions and depression. These findings add to a growing body of evidence indicating that anxiety disorders warrant further attention in relation to pain. The clinical and research implications of these findings are discussed.

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Author and article information

Contributors

: +39-03820-380329 , +39-02-700445467 , fabio.antonaci@unipv.it

Journal

Journal ID (nlm-ta): J Headache Pain

Title: The Journal of Headache and Pain

Publisher: Springer Milan (Milan )

ISSN (Print): 1129-2369

ISSN (Electronic): 1129-2377

Publication date (Electronic): 6 January 2011

Publication date PMC-release: 6 January 2011

Publication date (Print): April 2011

Volume: 12

Issue: 2

Pages: 115-125

Affiliations

[1 ]University Centre for Adaptive Disorders and Head pain (UCADH), Pavia, Italy

[2 ]Headache Medicine Centre, Policlinic of Monza, Monza, Italy

[3 ]Department of Child and Adolescent Neuropsychiatry, University La Sapienza, Rome, Italy

[4 ]Department of Neuroscience, Headache Centre, University of Parma, Parma, Italy

[5 ]Neurology Clinic, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy

[6 ]National Institute of Neurology IRCCS C, Mondino Foundation Pavia, Pavia, Italy

[7 ]University Consortium for Adaptive Disorders and Head pain (UCADH), Via Mondino 2, Pavia, 27100 Italy

Article

Publisher ID: 282

DOI: 10.1007/s10194-010-0282-4

PMC ID: 3072482

PubMed ID: 21210177

SO-VID: 868cd5b9-1d5f-414b-a9a6-9d627499f18d

History

Date received : 8 September 2010

Date accepted : 16 December 2010

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: depression,comorbidity,meta-analysis,migraine,psychiatric disorders

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: depression, comorbidity, meta-analysis, migraine, psychiatric disorders

Migraine and psychiatric comorbidity: a review of clinical findings

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Most cited references 63

Comorbidity of migraine and depression: investigating potential etiology and prognosis.

Comorbidity of migraine and psychiatric disorders--a national population-based study.

Depression and anxiety associated with three pain conditions: results from a nationally representative sample.

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