What conditions are comorbid with migraine and how to treat them
Comorbidity is defined as the presence of two or more chronic medical conditions that occur together at a greater than coincidental rate than what appears in the general population. It is common for people living with migraine to experience at least one comorbidity, according to Dr. Dawn Buse, Director of Behavioral Medicine at the Montefiore Headache Center and an associate professor in the Department of Neurology at the Albert Einstein College of Medicine in New York.
Comorbidities differ from underlying conditions in that they occur at the same time, but one does not necessarily cause the other. Because comorbidities are common in patients living with migraine, Dr. Buse says people shouldn’t be embarrassed by them.
“One thing I find in my work with patients with migraine is that they may feel personally embarrassed, ashamed or guilty about these comorbidities,” she says. “They may feel that it’s a sign that they’re not coping well enough with their migraine. I want people to know: This is just biology. This is just the way the human body is set up.”
Dr. Buse spoke with us about the different categories comorbidities fall into, as well as how people living with migraine can work with their health care provider to develop a personalized treatment plan.
Types of comorbidities
Psychiatric comorbidities include depression, anxiety, post-traumatic stress disorder (PTSD), panic disorders and suicide attempts, Dr. Buse says.
Depression is a particularly common comorbidity in people with migraine. Someone with episodic migraine, which is headache for 14 or fewer days per month, has a roughly 20 percent chance of depression, Dr. Buse says. Someone with chronic migraine, defined as 15 or more headaches per month, has between a 30 and 50% chance of depression, Dr. Buse says. “As the frequency of headache goes up—meaning more days per month—the chances of having depression are higher,” Dr. Buse says.
In addition, she says the rates for anxiety—an umbrella that includes generalized anxiety disorder (GAD), panic disorders and PTSD—are similar to those of depression, if not higher.
“Someone with chronic migraine has a 50% chance, maybe even up to an 80% chance, that they also experience anxiety,” Dr. Buse says, adding that these numbers make sense because people with migraine often feel anxiety about when their next migraine attack will occur and how it will affect their life.
Medical comorbidities include conditions such as asthma, allergic rhinitis, irritable bowel syndrome, hypertension, Crohn’s disease, chronic obstructive pulmonary disorder (COPD), chronic fatigue, sleep disorders and pain conditions such as fibromyalgia.
Neurologic comorbidities include conditions that affect the brain, such as epilepsy, multiple sclerosis and stroke.
There are competing ideas for why some of these medical conditions are comorbidities of migraine, Dr. Buse says. One theory is that the relationship is unidirectional, meaning one causes the other. Another theory is that the relationship can go both ways, with either one causing the other. A third theory is that there is an underlying mechanism, genetic or otherwise, that causes both migraine and the comorbidity.
Treating comorbidities of migraine
Treating comorbidities of migraine can be complex, and depends largely on the type of comorbidity. For example, someone who had a heart attack might be limited in the types of medication they can use to treat migraine, Dr. Buse says, as some migraine-specific medications like triptans cannot be used in someone who had a heart attack.
On the other hand, someone with anxiety or depression might see improvements in both their migraine and psychiatric condition with a treatment like cognitive behavioral therapy. “The nice thing about cognitive behavioral therapy is you learn ways to manage your thoughts and feelings, and change your behaviors, so that you can manage the hyper-excitable nervous system that comes along with having migraine,” Dr. Buse says.
Luckily, most comorbidities of migraine can be treated in some way. “The good news is, there are various treatments that can still be effective for migraine, even if you do have a limitation due to a comorbidity,” Dr. Buse says. Consult a headache specialist for help creating an effective migraine treatment plan that will encompass all of your potential comorbidities. “If you’re living with migraine and other comorbidities, it’s very valuable to see a headache specialist,” Dr. Buse says. “They understand that it is common for people with migraine to have these comorbidities.”
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