A new study published in The Journal of Pain reports a connection between a variety of pre-existing mental health disorders and the subsequent onset of severe or frequent migraines. Prior studies have shown this connection and that it occurs twice as often in people suffering from depression and anxiety. It is not yet clear if the connection exists among other mental health disorders.
An international team of researchers studied data from 19 World Health Organization World Mental Health Surveys in various countries involving more than 50,000 subjects. The investigation traced the association between pre-existing mood, anxiety, impulse control and substance use disorders with the subsequent onset of frequent or severe headaches.
The results showed that after adjusting for the variance of sex, age and mental disorder comorbidity, a wide range of mental illnesses increased the likelihood of developing severe and frequent headaches by 40 percent. This supports the hypothesis that those with mental health disorders may be more vulnerable to migraines.
The study also found that early onset of mental health disorders, those occurring before the age of 21, had a 21 percent higher risk for developing severe headaches than those with later onset disorders.
Migraines are characterized by headaches on one side of the head and throbbing pain, which is aggravated by movement. Other symptoms include nausea, sensitivity to light and sensitivity to noise including one’s own voice. Some patients experience visual impairments before the migraine begins. Accompanying symptoms are often psychiatric in nature such as depression, irritability, anxiety and more.
Todd A. Smitherman, Ph.D., points out that literature confirms that patients with migraines are significantly more likely to suffer from a psychiatric disorder than those without headache symptoms. Mental health disorders are more common in patients suffering from chronic migraines. Evidence has showed that the relationship between the two conditions can be bidirectional, meaning that some patients develop depression following migraines while others have a history of depression before the onset of migraines.
Most research has focused on the link between depression and migraines, but data show that anxiety conditions are the most common class of psychiatric disorders in the general population and almost twice as common in those suffering from migraines.
The quality of life for patients suffering from a combination of depression/anxiety and migraines is predictably poor. Treatment response is poor and there is the risk of medication overuse. Patients with the co-occurring conditions spend almost $5,000 more annually on health care than migraine patients without depression or anxiety. Even otherwise healthy college students who experience a migraine less than once a week showing symptoms of depression and anxiety, report reduced quality of life and miss more days of classes than students without migraines. The term ‘chronification’ has been used to describe the progression of migraine from episodic into chronic form.
The high rate of co-occurrence between migraines and psychiatric disorders suggest that all migraine patients should be screened for depression and anxiety. This may entail a brief verbal screening or an interview assessment for a patient suffering from chronic migraines. Patients with high levels of depression and anxiety should be assessed for medication overuse.
Antidepressants and anticonvulsants, which simultaneously treat both migraine and the psychiatric disorder, show some promise; however, these medications can cause some undesirable side effects. Cognitive behavioral therapy and relaxation training combined with medications specific to migraines can also help the conditions improve.
Future research will further reveal how the link between mental health disorders and migraines may be connected, in which case, a cure or at least effective treatment can be given.