Psychiatric Comorbidity of Migraine

Sandra W. Hamelsky, PhD, MPH; Richard B. Lipton, MD

Disclosures

Headache. 2006;46(9):1327-1333. 

In This Article

Abstract and Introduction

Abstract

Migraine affects nearly 12% of the adult population in the United States and causes significant lost productivity and decrements in health-related quality of life. The burden of migraine and the challenge in managing it are increased by the comorbid psychiatric conditions that occur in association with it. Studies in both clinical and community-based settings have demonstrated an association between migraine and a number of specific psychiatric disorders. This review will focus on the relationships between migraine and depression, generalized anxiety disorder, panic disorder, and bipolar disorder. In large scale population-based studies, persons with migraine are from 2.2 to 4.0 times more likely to have depression. In longitudinal studies, the evidence supports a bidirectional relationship between migraine and depression, with each disorder increasing the risk of the other disorder. Migraine is also comorbid with generalized anxiety disorder (Odds Ratio [OR] 3.5 to 5.3), panic disorder (OR 3.7), and bipolar disorder (OR 2.9 to 7.3). A diagnosis of migraine should lead to a heightened level of diagnostic suspicion for these comorbid psychiatric disorders. Similarly, a diagnosis of one of these psychiatric disorders should increase vigilance for migraine. Treatment plans for migraine should be mindful of the comorbid conditions.

Introduction

Migraine affects nearly 12% of the adult population in the United States,[1,2] and causes significant lost productivity[3,4] and decrements in quality of life.[5] Part of the burden of migraine is produced by the psychiatric conditions that occur in association with it. When one disorder occurs with another with greater than chance frequency the disorders are said to be comorbid. Studies in both clinical and community-based settings have demonstrated an association between migraine and a number of specific psychiatric disorders. While the association between migraine and depression is most widely reported, there are also strong associations with other psychiatric disorders. Understanding the nature of the association between migraine and these psychiatric disorders has implications for diagnosis and treatment. The occurrence of comorbidity may also provide clues to the etiology of each disorder. This review will focus on the relationships between migraine and depression, generalized anxiety disorder, panic disorder, and bipolar disorder.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....