Dr. Edmund Messina weighs in on conditions that occur concurrently with migraine

A comorbidity refers to a condition that occurs along with a primary disease. Migraine is comorbid with many diseases, and in many cases, these conditions affect one another. Understanding the relationship between comorbidities is extremely important when creating a migraine treatment plan that works for you.

In a recent Facebook Live event hosted by the American Migraine Foundation, Dr. Edmund Messina, a neurologist and headache specialist at the Michigan Headache Clinic, discussed tactics for controlling migraine in regard to comorbidities.

Treating Migraine and Comorbidities

According to Dr. Messina, “Headaches very rarely stand alone.” Knowledge of comorbidities is extremely important in creating effective treatment plans. One medication that may work well for migraine pain management can be detrimental to another condition. In fact, if a patient is taking medications for another condition, prescriptions for migraine “might interact with the medicines in such a way that they may even be toxic,” says Dr. Messina.

He emphasizes the importance of finding a headache specialist who is experienced and knowledgeable about migraine. “This person has to spend enough time with you to come up with a good diagnosis and to look at all your comorbidities and all the things that may be provoking these headaches,” says Dr. Messina. Medication will only be effective if all of a patient’s symptoms are evaluated and accounted for.

In order to accurately inform a health care provider of your symptoms, Dr. Messina recommends keeping a headache diary. He believes the best way to keep a headache calendar is by using a piece of paper marked with 31 lines for each day of the month. This way, doctors can note “blank” periods, consecutive days of headaches and can begin to pinpoint triggers.

Anxiety and Depression

Mood disorders affect 30% of people living with migraine. “About a third of all people if not more, who have migraine, especially migraine with aura, tend to have anxiety or depression problems,” says Dr. Messina. Anxiety and migraine attacks are comorbidities that affect one another. When someone is more anxious, they are more likely to have a migraine attack. “We all have had the experience where we have a migraine triggered by a stressful situation,” says Dr. Messina. “And this comorbidity of anxiety, stress will trigger a headache.”

In order to treat these conditions simultaneously, Dr. Messina recommends venlafaxine, which he finds produces very effective results in treating migraine, anxiety and depression.

Neck Pain

Neck pain often accompanies migraine. “We have solid data that shows that migraine itself radiates pain to the neck,” says Dr. Messina. A severe migraine attack causes posterior pain in the back of the head and up the top of the neck. “The whole system mingles together when the battle for migraine is being fought,” says Dr. Messina. He adds that physical therapy and occipital nerve blocks are two potential ways to manage neck pain caused by migraine.


Fibromyalgia is a very common comorbidity to migraine. Patients who experience both migraine attacks and fibromyalgia experience significantly more anxiety, insomnia and depression than those with migraine alone.

Fortunately, many of the medications that are effective for treating migraine also work well for fibromyalgia. Gabapentin or pregabalin are commonly prescribed for fibromyalgia, and though they are not officially considered preventive treatments for migraine, Dr. Messina says many patients have had success in treating both conditions.


Insomnia and sleep deprivation are both common triggers for migraine. Insomnia can worsen migraine attacks just as migraine can worsen sleeping problems. Dr. Messina recommends patients visit a sleep specialist if they have significant sleep issues so that their potential sleep disorders can be identified, and help their primary health care provider make a more informed diagnosis.

To find more information and advice from leading neurologists and headache specialists like Dr. Messina, visit the American Migraine Foundation’s resource library. Use our doctor-sourced fact sheets, toolkits, and advice to learn more and find a headache doctor near you.