Migraine and psychiatric comorbidity: a review of clinical findings

Abstract

Migraine is an extremely common disorder. The underlying mechanisms of this chronic illness interspersed with acute symptoms appear to be increasingly complex. An important aspect of migraine heterogeneity is comorbidity with other neurological diseases, cardiovascular disorders, and psychiatric illnesses. Depressive disorders are among the leading causes of disability worldwide according to WHO estimation. In this review, we have mainly considered the findings from general population studies and studies on clinical samples, in adults and children, focusing on the association between migraine and psychiatric disorders (axis I of the DSM), carried over after the first classification of IHS (1988). Though not easily comparable due to differences in methodology to reach diagnosis, general population studies generally indicate an increased risk of affective and anxiety disorders in patients with migraine, compared to non-migrainous subjects. There would also be a trend towards an association of migraine with bipolar disorder, but not with substance abuse/dependence. With respect to migraine subtypes, comorbidity mainly involves migraine with aura. Patients suffering from migraine, however, show a decreased risk of developing affective and anxiety disorders compared to patients with daily chronic headache. It would also appear that psychiatric disorders prevail in patients with chronic headache and substance use than in patients with simple migraine. The mechanisms underlying migraine psychiatric comorbidity are presently poorly understood, but this topic remains a priority for future research. Psychiatric comorbidity indeed affects migraine evolution, may lead to chronic substance use, and may change treatment strategies, eventually modifying the outcome of this important disorder.

Headache in Children and Adolescents

“…Epidemiological studies have established a strong association between primary headaches and psychiatric disorders and the reported rates ranged between 56.4-70.3% in migraine and 36.4-77.8 % in TTH [30,[48][49][50][51][52] . In one study, 29.6% of CDH patients met criteria for at least one current psychiatric diagnosis, and 34.9% met criteria for at least one-lifetime psychiatric diagnosis [53] .…”

“…In one study, 29.6% of CDH patients met criteria for at least one current psychiatric diagnosis, and 34.9% met criteria for at least one-lifetime psychiatric diagnosis [53] . Depressive and anxiety disorders being the common disorders, other being dysthymia, phobic disorder, obsessive compulsive disorder, somatoform disorders, sleep difficulties and disorders (insufficient and poorer sleep quality, co-sleeping with parents, anxiety related to sleep, night waking, nightmares, bedwetting and pavor), suicidal ideation and an increased risk of suicidality [30,48,[50][51][52][54][55][56][57][58][59][60][61] .The lifetime prevalence of major depression was threefold higher in persons with migraine and in persons with a severe headache compared with controls [62] .TTH is associated with fewer close friends and had a higher rate of divorced parents [63] . Previous studies have shown a significant negative correlation between total intelligence quotient, verbal intelligence quotient, performance intelligence quotient and the frequency of headache attacks [64] .…”

“…Previous studies have shown a significant negative correlation between total intelligence quotient, verbal intelligence quotient, performance intelligence quotient and the frequency of headache attacks [64] . Neurological disorders associated with a headache and migraine, are mainly epilepsy, ADHD and Tourette syndrome [52,55,61,65] .The prevalence of epilepsy in patients with migraine varies from 1 to 17%, with an average of 5.9%, and greatly exceeds that of the general population (0.5-1%) [61] . The risk of migraine is more than twice as high in subjects with epilepsy both in probands and in relatives, compared to people without epilepsy [66] .The most obvious association is between migraine with aura (MWA) and epilepsy, with a high prevalence of MWA (30.4%) than other types of primary headache in children with seizures [67] .…”

“…Common genetic and environmental risk factors may underlie both migraine and psychiatric disorders [52,67] . The mechanisms underlying the association between headache and neuropsychiatric co-morbidities are poorly understood, but both pathophysiological (e.g., serotonergic dysfunction, hormonal influences, shared mechanism in structures of the central nervous system between pain and affective disorders, perhaps involving Limbic activation, dysregulation of the hypothalamic-pituitaryadrenal axis) and psychological (eg, interoceptive conditioning, fear of pain, anxiety sensitivity, avoidance behavior) factors are implicated.…”

Migraine and Reward System—Or Is It Aversive?

“…There is overwhelming evidence demonstrating the comorbidity of psychiatric illness in patients with migraine [81,82]. Studies suggest mood and anxiety disorders generate the most prevalent subset, with more than 47 % of migraineurs meeting criteria for these conditions [83,84].…”