Understanding why diseases can occur in association with migraine
Other illnesses that can appear alongside migraine, called comorbidities, can affect any number of body systems, and often require more complex treatment plans. According to Dr. Nate Bennett, Director of the Preferred Headache Center in Pittsburgh, PA, comorbid diseases are more common in people with migraine, because the hyperactive pain receptors in their brain have difficulty filtering out unnecessary signals from both the body and the outside world.
In a recent Facebook live chat hosted by the American Migraine Foundation, Bennett discussed the more common comorbidities of migraine, why they occur, and offered insights on their respective treatment options.
Depression and anxiety
Patients with migraine are 25% more likely to have depression and 50% more likely to have anxiety. These diseases are commonly classified as mental health disorders, but Bennett prefers to use the term “limbic dysfunction,” in reference to the area of the brain that controls emotions and memory.
“Patients with migraine often have imbalanced limbic systems as well, so the emotional part of their brain will misinterpret environmental stimuli or stressors,” Bennett said. “Logically, they may know something should only cause a bit of anxiety, when it’s really causing them much more.”
This signal mix-up works similarly with depression and bipolar disorder. All three diseases can increase a person’s likelihood of having migraine, and vice versa, because the diseases are heavily influenced by stress. Stress can worsen the limbic dysfunction, which in turn puts strain on the pain pathways involved in migraine.
“You’ve probably heard the commercial where they say ‘depression hurts,’” Bennet said. “Well, it really does. It lowers the pain threshold, making patients more likely to get more migraines, which can cause heightened depression and anxiety. It creates a vicious cycle.”
Bennett recommended using medications that treat both diseases. Some antidepressants, like Cymbalta or Effexor, can help manage both migraine and depression/anxiety symptoms. Stress management techniques like meditation have also shown to be helpful as well.
A large number of people living with migraine also have fibromyalgia, a chronic pain disorder that affects specific muscles. Like migraine, it’s an invisible illness that can’t be diagnosed with a blood test or an X-ray. As a result, even some physicians question the validity of this disorder.
“Whether it’s due to the brain misperceiving signals or receiving pain signals at the wrong time, the bottom line is, there is pain,” Bennett said. “One of the reasons some physicians don’t believe it exists is because there’s nothing to measure. It’s quite similar to migraine in that way.”
Comorbid fibromyalgia can be treated similarly to comorbid anxiety and depression. Some antidepressants have shown to be helpful in managing pain, but Bennett believes that exercise, although difficult, may help the most.
“Yoga has proven to be very helpful for people with fibromyalgia,” Bennett said. “The hard part is, sometimes exercise can initially cause more pain, so it can be be very difficult for people to go out and get started. It’s easy for physicians to say to say ‘go out and exercise’ because they’re not in pain. I still try to get my patients to push themselves, because the more they do it, the lower the pain should go, hopefully.”
Managing migraine to manage comorbidities
Many people with migraine try to plan their life around their disease to avoid triggers and sudden attacks. Unfortunately, the pressure of that kind of self-monitoring can heighten anxiety, triggering migraine and other associated comorbidities. According to Bennett, getting your migraine under control is the best way to avoid this cycle.
“There are many lifestyle changes that can be made to help manage migraine,” Bennett said. “Drink plenty of water, avoid foods that trigger your migraine, get plenty of sleep, exercise. All these little changes can help get your headache under control.”
Knowledge is a powerful tool for migraine management, which is why it’s important to stay up to date on news and the latest research. The American Migraine Foundation maintains a comprehensive resource library full of fact sheets, toolkits and advice sourced directly from the nation’s leading migraine specialists, and distributes a monthly newsletter with the latest migraine news you need to know. Visit AMF’s website to learn more and to find a headache doctor near you.