Migraine and psychiatric comorbidity: a review of clinical findings

Fabio Antonaci,Federica Galli,Giuseppe Nappi,Alfredo Costa,Paolo Calabresi,Gian Camillo Manzoni

doi:10.1007/s10194-010-0282-4

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.

Highlights

Migraine is an extremely common disorder, characterized by the recurrence of painful and non-painful episodic phenomena and a variety of neurological manifestations
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, carried over after
There would be a trend towards an association of migraine with bipolar disorder, but not with substance abuse/dependence

Summary

Introduction

Migraine is an extremely common disorder, characterized by the recurrence of painful and non-painful episodic phenomena and a variety of neurological manifestations. A recent clinical study [47] showed a connection between childhood maltreatments, adult chronic and/or severe migraine and major depression: migraineurs with current depression reported more frequent physical and sexual abuse compared to those without depression; women with major depression were more likely to report sexual abuse occurring before 12 years, and the relationship was stronger when abuse occurred both before and after 12 years; women with migraine and depression were four times more likely to have a history of some type of childhood maltreatment These findings outline the interface existing between neurology and psychiatry, organic and psychological, and likely genetic and environmental factors linked to migraine. Both psychiatric comorbidity and headache familial recurrence are very frequent in children with other headaches, but they can occur together or alone This pattern of results suggests that anxiety/depression and headache familial recurrence act as additive factors in non-migrainous headaches, while in migraine they might represent, together with psychiatric disorders in parents, interrelated aspects of a more complex relationship. Ratcliffe et al [19] Hung et al [37] Jette et al [18] Camarda et al [23] Merikangas et al [27] Breslau et al [56] Samaan et al [30] Lipton et al [21] Lanteri-Minet et al [58] Breslau et al [24] Kececi et al [59] McWilliams et al [60]

18–65 ND 15–over 65 ND 27–28 25–55 19–85 18–65 ND 25–55 Over 18 25–74

Findings

Conclusions