Why it is important for mental health clinicians to learn about migraine

By Rajnish Mago, MD (bio)

All mental health clinicians should be familiar with migraine—its clinical features, diagnosis, and treatment. Why do I make such a bold statement? To motivate you to read the material about migraine (see Related Pages below), here are my reasons:

1. Migraine is a very common condition. It occurs in about 12% of adults (Yeh et al., 2018).

2. In case we are tempted to think that it is very common but not necessarily that significant clinically, we should note that it is the third most common cause of disability for persons under the age of 50 years, both men and women (according to the Global Burden of Disease 2015 Study; Steiner et al., 2016).

3. There are many studies that have shown that persons with migraine are MUCH more likely than others to have or to subsequently be diagnosed with a depressive disorder (Zhang et al., 2019), bipolar disorder (Minen et al., 2016), anxiety disorders, substance use disorders (e.g., opioid use disorder), and other mental disorders.

4. The flip side of that is that migraine is common in persons with major depressive disorder, bipolar disorders (especially bipolar II disorder), and several other mental disorders (Amoozegar, 2017; Minen et al., 2016; Leo and Singh, 2016; Fornaro et al., 2015; Buse et al., 2013).

5. When psychiatric comorbidities are present, this tends to predict a worse outcome for the migraine-–more disability, less response to treatment, more medication overuse, worse quality of life, greater chance that the migraine will become chronic (Minen et al., 2016; Buse et al., 2013).

Bottom line

Migraine is probably present in a LOT of our patients even though we may not have specifically identified this. And, it interacts with the mental health issues in many ways, worsening the patient’s prognosis. Maybe we need to make a specific effort to become aware of migraine in our patients?

What do you think? Please do post your comments at the bottom of this page—under “Leave a Reply.”

Related Pages

The four phases of migraine

The prodromal phase of migraine

The migraine aura

Migraine headache and associated symptoms

The postdromal phase of migraine

How to diagnose migraine and its subtypes

References

Amoozegar F. Depression comorbidity in migraine. Int Rev Psychiatry. 2017 Oct;29(5):504-515. doi: 10.1080/09540261.2017.1326882. Epub 2017 Jul 6. Review. PubMed PMID: 28681617.

Burch R, Rizzoli P, Loder E. The Prevalence and Impact of Migraine and Severe Headache in the United States: Figures and Trends From Government Health Studies. Headache. 2018 Apr;58(4):496-505. doi: 10.1111/head.13281. Epub 2018 Mar 12. PubMed PMID: 29527677. Not used because it combined migraine and “severe headache.”

Buse DC, Silberstein SD, Manack AN, Papapetropoulos S, Lipton RB. Psychiatric comorbidities of episodic and chronic migraine. J Neurol. 2013 Aug;260(8):1960-9. doi: 10.1007/s00415-012-6725-x. Epub 2012 Nov 7. Review. PubMed PMID: 23132299.

Fornaro M, De Berardis D, De Pasquale C, Indelicato L, Pollice R, Valchera A, Perna G, Iasevoli F, Tomasetti C, Martinotti G, Koshy AS, Fasmer OB, Oedegaard KJ. Prevalence and clinical features associated to bipolar disorder-migraine comorbidity: a systematic review. Compr Psychiatry. 2015 Jan;56:1-16. doi: 10.1016/j.comppsych.2014.09.020. Epub 2014 Sep 28. Review. PubMed PMID: 25306379.

Leo RJ, Singh J. Migraine headache and bipolar disorder comorbidity: A systematic review of the literature and clinical implications. Scand J Pain. 2016 Apr;11:136-145. doi: 10.1016/j.sjpain.2015.12.002. Epub 2016 Feb 23. Review. PubMed PMID: 28850455.

Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF; AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007 Jan 30;68(5):343-9. PubMed PMID: 17261680. Not used because it is based on a mailed survey.

Minen MT, Begasse De Dhaem O, Kroon Van Diest A, Powers S, Schwedt TJ, Lipton R, Silbersweig D. Migraine and its psychiatric comorbidities. J Neurol Neurosurg Psychiatry. 2016 Jul;87(7):741-9. doi: 10.1136/jnnp-2015-312233. Epub 2016 Jan 5. Review. PubMed PMID: 26733600.

Steiner TJ, Stovner LJ, Vos T. GBD 2015: migraine is the third cause of disability in under 50s. J Headache Pain. 2016 Dec;17(1):104. Epub 2016 Nov 14. PubMed PMID: 27844455; PubMed Central PMCID: PMC5108738.

Yeh WZ, Blizzard L, Taylor BV. What is the actual prevalence of migraine? Brain Behav. 2018 Jun;8(6):e00950. doi: 10.1002/brb3.950. Epub 2018 May 2. PubMed PMID: 30106228; PubMed Central PMCID: PMC5991594.

Zhang Q, Shao A, Jiang Z, Tsai H, Liu W. The exploration of mechanisms of comorbidity between migraine and depression. J Cell Mol Med. 2019 May 20. doi: 10.1111/jcmm.14390. [Epub ahead of print] Review. PubMed PMID: 31106971.

Copyright 2019, Rajnish Mago, MD. All rights reserved. May not be reproduced in any form without express written permission.

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