Comorbidity of Migraine and Psychiatric Disorders Common, Lead to Poorer Outcomes

June 29, 2007

June 29, 2007 (Chicago) -- A comprehensive Canadian population-based study looking at the prevalence of several psychiatric conditions in association with migraine suggests that health-related outcomes are poorer in those patients suffering from migraines and a psychiatric disorder than those with either condition alone.

This study was presented here at the American Headache Society 49th Annual Scientific Meeting.

Nathalie Jetté, MD, assistant professor of neurology from the University of Calgary, Alberta and lead author on the paper, reported that migraine was associated in their study with major depressive disorder, bipolar disorder, panic disorder, and social phobia in this sample.

"Understanding the psychiatric correlates of migraine is important to adequately manage this patient population and to guide public health policies regarding health services utilization and healthcare costs," the authors conclude.

National Survey

There is an estimated lifetime prevalence that 7% to 17% of the Canadian population suffers migraine, which is more common in females, with a female/male ratio of 3.1 and a peak prevalence between the ages of 25 and 44 years, Dr. Jetté said.

Data from the 2002 Canadian Community Health Survey, a national health survey, were used for this study. The survey included information from the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) administered to a sample of 36,984 subjects. Subjects were interviewed at home; if they refused to be interviewed in person or travel was prohibitive, telephone interviews were conducted (5173/36,984).

The conditions evaluated were major depressive disorder (MDD), bipolar disorder, panic disorder, agoraphobia, social phobia, and substance dependence. Subjects were read a list of chronic medical conditions and asked if a health professional had diagnosed them with any of these conditions. The time frame was having the condition 6 months or longer. The interviewers were seeking to document quality of life, 2-week disability, restriction of activities, and mental healthcare utilization.

The prevalence of physician-diagnosed migraine was 15.2% for females and 6.1% for males, the authors reported. Migraine was most common in those between the ages of 25 and 44 years and in those with a 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," the authors write. However, migraine was not associated with substance dependence.

The higher prevalence of psychiatric disorders in migraineurs was not related to sociodemographic variables, they note. "Health-related outcomes (disability, quality of life, restriction of activities) were worst in those with both migraines and a psychiatric disorder and intermediate in those with either condition alone," they concluded.

"If these conditions are not addressed, it's a heavy burden on society," Dr. Jetté told attendees here.

She pointed to several limitations of the study during her presentation, including the fact that International Classification of Headache Disorders, 2nd ed (ICHD-II) criteria for migraine diagnosis were not used, but rather that migraine was self-reported by patients. "Future studies are needed to elucidate the mechanism of the association between migraine and mental health conditions and to confirm our findings using ICHD-II criteria," she concluded.

Clinical Impression Confirmed

Joel Saper, MD, director of the Michigan Headache and Neurological Institute, in Ann Arbor, a conference attendee not associated with this study, pointed out that it is well-known that migraine is often accompanied by neuropsychiatric conditions such as depression and anxiety, which are characterized as comorbidities of migraine. "By definition, they occur in association with migraine more frequently than by chance alone," he told Medscape. "There is evidence that these conditions share certain biologic and/or genetic commonalities with migraine."

This paper, looking at the prevalence of several psychiatric conditions in association with migraine, he said, "confirms the widespread clinical impression that the presence of these comorbidities makes the treatment of migraine more difficult. This may be as a result of neurobiological reasons or because the psychiatric conditions serve as a barrier to effective treatment or are a provocative influence for headache events."

This study was supported by an operating grant from the Research Coordinating Committee of the Institute of Health Economics (IHE) received by Scott B. Patten, MD, 1 of the coinvestigators of the study. IHE is governed by a board of 16 directors; 8 represent the universities of Alberta and Calgary, 4 represent government, and 5 represent industry. The institute performs research in health economics and synthesizes evidence in health technology assessment to assist health policy-making and best medical practice.

American Headache Society 49th Annual Scientific Meeting: Abstract 45. June 7-10, 2007.

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