The first treatments often prescribed for Migraine are abortives or other acute pain medications to relieve the symptoms of an attack. As tempting as it may be to rely only on acute treatments, using many of these medications too frequently can cause medication overuse headache (MOH). While it is understood that chronic Migraine is associated with MOH, less is understood about the link between MOH and mental health comorbidities such as anxiety and depression.
Previous research suggests that depression and anxiety may be a risk factor for MOH. Those studies have often relied on patient recall rather than collecting data in real time.
A recent study investigated the association between Migraine-related disability, medication overuse, and comorbid depression and anxiety.
- 370 subjects with a Migraine diagnosis
- Collected demographic information
- Each subject completed the MIDAS and HIT-6
- Screened for previous diagnosis of anxiety or depressive disorder
- Subjects recorded presence or absence of headache in daily electronic diary
- Chronic Migraine present in 16 percent
- Medication overuse found in 17.2 percent
- Anxiety disorders present in 34.4 percent
- Depressive disorders present in 45.7 percent
- No demographic variable associated with medication overuse
- Psychiatric disorders not associated with medication overuse
- HIT-6 results not associated with medication overuse
- When controlled for headache days, MIDAS results not associated with medication overuse
- Migraine patients with comorbid anxiety or depressive disorders were not more likely to overuse acute medications
- Chronic migraine was the only predictor of medication overuse
- This was the first study to obtain these findings
- Previous studies have used retrospective recall (relying on patient memory of past events) that may have been less accurate
Implication for patients
As further research clarifies the association between medication overuse, transition from episodic to chronic migraine, and psychiatric comorbidities, we can expect improvements in patient screening and treatment recommendations. In the meantime, increase your odds of Migraine success by sharing your mental health history with your Migraine doctor.
1 Butler N, Nicholson R, Seng E. (2017). Associations Between Psychiatric Symptoms, Migraine Disability, and Medication Overuse in People with Migraine: Secondary Analysis of a Naturalistic Diary Study, Program Abstracts from the American Headache Society’s 59th Annual Scientific Meeting. doi: 10.1111/head.13102.
2 Lampl C, Thomas H, Tassorelli C, et al. (2011). Headache, depression and anxiety: associations in the Eurolight project, The Journal of Headache and Pain, (2016) 17:59. doi: 10.1186/s10194-016-0649-2.
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Headache disorders counselor and advocate Tammy Rome maintains a private practice specializing in treating clients with Migraine and other headache disorders. She also volunteers as vice chair of the American Headache and Migraine Association and as president of The Cluster Headache Support Group. You can read more of Tammy’s work on her website and follow her on Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.