Migraine Associated with Mental Health Disorders

Patient Expert

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Evidence has long indicated that Migraine disease is associated with mental health disorders. In 2000, a study showed major depressive disorder to impact 47% of Migraineurs as opposed to 17% of the general population.3 A new study used a large population-based sample to analyze the association between Migraine disease and mental health disorders.

Study methods:

  • Sareen and his colleagues drew and analyzed data from the German Health Survey, which was conducted from 1997 to 1999.
  • Migraine was diagnosed by physicians as opposed to being self-reported by study participants.
  • Trained interviewers evaluated study participants for mental health disorders using the German National Health Interview and Examination Survey - Mental Health Supplement (GHS-MHS).
  • Lifetime and 12-month history of Migraines were assessed.
  • Lifetime and 12-month history of mental health disorders were assessed.

Study results and conclusions:

  • Out of 7,124 adults, 11.7% had a history of Migraine. This is consistent with World Health Organization estimates of 12% prevalence of Migraine in the world's general population.
  • Past-year Migraine was associated with:
  • major depressive disorder

  • dysthymia

  • bipolar disorder

  • panic attacks

  • panic disorder

  • agoraphobia

  • simple phobia

  • Substance abuse and dependence disorders were NOT found to be associated with Migraine.

  • Migraines may be a risk factor for major depressive disorder.

  • Anxiety often preceded Migraine; Migraine then often preceded depression.

**Excerpts from Sareen et al discussion section:**1

"Our analyses allow associations to be made but prospective studies would be needed in order to better address whether migraine is a risk factor for the development of mental disorders or whether mental disorders are risk factors for the development of migraine, or both."

"In conclusion, the significant associations between migraine and mood disorders as well as panic attacks, panic disorder, simple phobia, and agoraphobia are important findings for psychiatry/psychology and general health care. It is important for the general physician to recognize the association between migraine and mental health and to include a proper history, physical examination and investigations for other conditions when mental or physical disorders are present. This knowledge is vital to the holistic treatment of these comorbid patients. It is also important for the psychiatrist to understand how migraine interacts with the mental health issues they encounter."

Summary and comments:

This study builds upon and confirms findings of previous studies. Previous studies established clear connections between Migraine disease and major depressive disorder3, bipolar disorder4,5, and anxiety disorders6.

It is still unclear whether the relationship is that of comorbidity (two or more conditions occurring at the same time, but not causing each other) or if there is a causative relationship in which one disorder causes the other. At present, the theory of these disorders being comorbid is more prevalent. More research is needed to answer this question.

The present implication for patients and doctors is to be aware of this connection in order to be alert for and treat both Migraine and any mental health conditions that may exist.

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Resources:

1 Ratcliffe, Gregory E., BSc; Enns, Murray W., .D, FRCP.; Jacobi, Frank, PhD; Belik, Shay-Lee, MSc; Sareen, Jitender, MD, FCDPD. "The relationship between migraine and mental disorders in a population-based sample." General Hospital Psychiatry 31 (2009) 14-19.

2 "Migraines and mood disorders may be connected." New York. Reuters Health. January 21, 2009.

3 Lipton, R.B., MD; Hamelsky, S. W. , MPH; Kolodner, K. B., ScD; Steiner, T. J., MB, PhD; Stewart, W. F., PhD, MPH. "Migraine, quality of life, and depression." Neurology 2000;55:629-635.

4 Low, Nancy C. P., du Fort, Guillaume Galbaud & Cervantes, Pablo (2003) "Prevalence, Clinical Correlates, and Treatment of Migraine in Bipolar Disorder." Headache: The Journal of Head and Face Pain 43 (9), 940-949. doi: 10.1046/j.1526-4610.2003.03184.x

5 McIntyre, Roger S., Konarski, Jakub Z., Wilkins, Kathryn, Bouffard, Beverley, Soczynska, Joanna K. & Kennedy, Sidney H. (2006) "The Prevalence and Impact of Migraine Headache in Bipolar Disorder: Results From the Canadian Community Health Survey." Headache: The Journal of Head and Face Pain 46 (6), 973-982. doi: 10.1111/j.1526-4610.2006.00469.x

6 Sareen, Jitender, BSc, MD, FRCPC; Jacobi, Frank, PhD; Cox, Brian J., PhD; Belik, Shay-Lee, BSc(Hons) ; Clara, Ian, MA; Stein, Murray B., MD, MPH. "Disability and Poor Quality of Life Associated With Comorbid Migraine Disorders and Physical Conditions." Arch Intern Med. 2006;166:2109-2116.