The Impact of Post‐Traumatic Stress Disorder on the Burden of Migraine: Results From the National Comorbidity Survey‐Replication

Abstract

Background Post-traumatic stress disorder (PTSD) has been linked with migraine in prior studies. Objective To evaluate the individual and joint burdens of migraine and PTSD in a population-based cohort. Methods The National Comorbidity Survey-Replication (NCS-R) is a general population study conducted in the United States from February 2001–April 2003. PTSD and migraine were assessed, and four groups defined based on their migraine and PTSD status. The four groups included those with no migraine and no PTSD (controls, n=4535), those with migraine and without PTSD (migraine alone, n=236), those with PTSD and without migraine (PTSD alone, n=244), and those with both migraine and PTSD (mig+PTSD, n=68). Logistic and Poisson regression models were used to assess the association between dichotomous/multilevel outcome variables indicating financial, health, and interpersonal burdens and each migraine/PTSD group. Results Compared to controls, those with Mig+PTSD were more likely to be in the low poverty index (48% vs 41%, AOR 2.16; CI: 1.10, 4.24) and were less likely to be working for pay or profit in the past week (50% vs 68%, AOR 0.42; CI: 0.24, 0.74) but not those with migraine or PTSD alone. Additionally, the number of days where work quality was cut due to physical or mental health or substance abuse in the past month was greater in all groups compared to controls: (1) migraine alone: mean 2.57 (SEM 0.32) vs mean 1.09 (SEM 0.08) days, ARR=2.39; CI: 2.19, 2.62; (2) PTSD alone: mean 2.43 (SEM 0.33) vs mean 1.09 (SEM 0.08) days, ARR=2.09; CI: 1.91, 2.29; (3) mig+PTSD: mean 8.2 (SEM 0.79) vs 1.09 (SEM 0.08) days, ARR 6.79; CI 6.16, 7.49; and was over 2.5-fold greater in those mig+PTSD than migraine alone (mean 8.0 [SEM 0.79] vs 2.6 days [SEM 0.72], ARR 2.77; CI: 2.45, 3.14). The likelihood of having difficulty getting along or maintaining a social life was also increased in all groups relative to controls: (1) migraine alone: 21% vs 5.4%, AOR 4.20; CI: 2.62, 6.74; (2) PTSD alone: 18% vs 5.4%, AOR 3.40; CI: 2.40, 4.82; (3) Mig+PTSD: 39% vs 5.4%, AOR 9.95; CI: 5.72, 17.32, and was 2-fold greater in those with Mig+PTSD as compared to those with migraine alone (AOR 2.32; CI: 1.15, 4.69). Conclusions These findings support the need for those who treat migraine patients to be aware of the comorbidity with PTSD, as these patients may be particularly prone to adverse financial, health, and interpersonal disease burdens.

Migraine and its psychiatric comorbidities

“…In addition, the psychological consequences of abuse and its sequelae, including PTSD and depression, are important treatable comorbidities of migraine. This is especially important because migraineurs with PTSD were found to have greater disability and more lost work days due to physical or mental health or substance abuse (8 days for migraineurs with PTSD compared with 2.6 days for migraineurs without PTSD, adjusted rate ratio 2.77 (95% CI 2.45 to 3.14)), and more difficulties with developing and maintaining a social life than migraineurs without PTSD (adjusted OR 2.32 (95% CI 1.15 to 4.09)) 50 51. Cognitive–behavioural therapy (CBT) for PTSD was found to improve the disability of patients with migraine with comorbid PTSD 52…”

The Role of Negative Affect on Headache‐Related Disability Following Traumatic Physical Injury

“…Postinjury posttraumatic stress disorder (PTSD), depression, and anxiety are treatable factors that may serve as intervention targets given their robust associations with general headache pain and disability and their frequent development following traumatic physical injury. Specifically, up to 24% of injured trauma patients report a new‐onset psychiatric disorder 12 months postinjury .…”

2015 Headache Members’ Choice Award

“…We are grateful to the members of the American Headache Society for selecting this manuscript. We are particularly honored that our paper was selected from such an impressive field of nominees with topics ranging from an unusual case study to analyses of large‐scale epidemiologic databases …”

“…We are particularly honored that our paper was selected from such an impressive field of nominees with topics ranging from an unusual case study to analyses of large-scale epidemiologic databases. [2][3][4][5] This manuscript was intended as a step toward closing the gap between clinical trials and clinical practice in the evidence-based, acute treatment of migraine. Clinical trials rigorously evaluate the effects of treatment and have the strengths of specific hypotheses, clear eligibility criteria, random allocation to well-defined treatment groups, doubleblinding and defined endpoints.…”