Migraine Comorbidity : Overview

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Migraine commonly co-occurs with a variety of psychiatric, neurologic, vascular, cardiac, and other disorders (Table 1). In some instances migraine may be comorbid with certain disorders because of uncertainty related to diagnosis or overlapping symptomatology. This is the case, for instance, with migraine and epilepsy, which are both associated with headache as well as transient alterations of consciousness and migraine aura and stroke, which share common features.[1]

Table 1. Conditions Reported Comorbid With Migraine

Category

Condition

Psychiatric
  • Depression
  • Anxiety
  • Panic disorder
  • Bipolar
Neurologic
  • Epilepsy
  • Tourette’s*
Vascular
  • Raynaud’s phenomenon
  • Blood pressure (inconsistent)
  • Ischemic stroke, sub-clinical stroke, white matter abnormalities
Cardiac
  • Patent foramen ovale*
  • Mitral valve prolapse*
  • Atrial septal aneurysm*
Other
  • Asthma/allergy
  • Systemic lupus erythematosus*
  • Non-headache pain
*Data from clinical samples onlyFrom Scher AI, Bigal ME, Lipton RB. Curr Opin Neurol. 2005;18:305-10.

 


Impact of Migraine Comorbidity

Comorbid conditions occurring in migraine patients add a considerable burden to the considerable negative impacts associated migraine. This is illustrated by recent results from the American Migraine Prevalence and Prevention Study (AMPPS), which examined the impact of migraine on health and functioning in a large population-based sample. The study found that among patients with episodic migraine, both depression and anxiety diagnosis significantly predicted greater adverse headache impact (depression: Beta, 3.7; 95% CI: 2.79, 4.62; anxiety: Beta, 1.24; 95% CI: 0.25, 2.24; P<0.05). Additionally, among patients with chronic migraine, depression diagnosis was also a significant predictor of greater adverse headache impact (Beta, 3.22; 95% CI: 1.05, 5.39; P<0.05).[2]

Migraine Comorbidity and Treatment

Management of migraine is typically focused in two areas: (1) on acute treatment for resolving migraine episodes in progress or (2) prophylactic treatment for preventing or decreasing the severity or frequency of episodes. Only recently has due emphasis been placed on the importance of successful management of comorbid disorders as a means of decreasing the disability associated with migraine.[3] Comorbidity is an important factor that informs selection of drug treatment for migraine. In migraine patients with comorbid conditions, treatment should be individualized to avoid therapeutics that may exacerbate a co-occurring disorder. Additionally, certain pharmacotherapy options, such as antidepressants in patients with comorbid migraine and depression, may allow successful management of both disorders.[4]

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