Migraines linked to mental disorders

Migraine headaches can precede the onset of mental disorders, according to a growing body of knowledge that includes a new study in the January-February 2009 issue of General Hospital Psychiatry.

"Together, migraine and mental disorders cause more impairment than alone," said lead study author Gregory Ratcliffe. "Patients who have one condition should be assessed for the other so they can be treated holistically. Although it is important to know that both are present, treating one will have an effect on the other."

Ratcliffe is with the department of psychiatry at the University of Manitoba in Canada. He and his colleagues analyzed data on 4,181 participants in the German National Health Interview and Examination Survey. Migraines were diagnosed by a physician and trained interviewers evaluated participants for mental disorders.

Researchers found that 11 percent of participants had migraines. Participants had a variety of disorders: major depression, general anxiety disorder, dysthymia, bipolar disorder, panic attacks, panic disorder, substance abuse disorders, agoraphobia and simple phobia.

The authors considered two theories that might explain the relationship between migraine and mental disorders. The first theory is that a common factor influences both conditions, such as low activity of enzymes that deactivate certain chemical messages sent to the brain. They also considered a causal relationship: This study and others found that anxiety often precedes migraine, which often precedes depression.

Frederick Taylor, M.D., director of the Park Nicollet Headache Clinic in St. Louis Park, Minn., said that migraine co-morbidities - depression, anxiety and other disorders - affect 83 percent of migraineurs and explain 65 percent of their inability to function in life, more than the pain itself.

According to MAGNUM, a national migraine awareness group, 30 million Americans suffer from migraines and another 8 million are genetically susceptible. Those who suffer from the most disabling type of migraine, intractable migraine, can find it a struggle to function in the workplace.

General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.

Ratcliffe GE, et al. The relationship between migraine and mental disorders in a population-based sample. General Hosp Psychiatry , 31(1), 2009.

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