Do Psychiatric Disorders Increase the Risk for Migraines?
November 1, 2000
Do Psychiatric Disorders Increase the Risk for Migraines?
ABSTRACT & COMMENTARY
Source: Swartz KL, et al. Mental disorders and the incidence of migraine headaches in a community sample. Arch Gen Psychiatry 2000;57:945-950.
Several studies have demonstrated a cross-sectional relation between psychopathologic features and migraine headaches, but few studies have examined the temporal relationship between specific psychiatric disorders and migraine headaches. In one study, Breslau and associates found a bidirectional relationship between migraine and depression, concluding that the results favored a shared mechanism, rather than depression being a biological or psychological response to migraine.1 In another study, Breslau et al reported that depression did not predict an increase in the incidence of other severe headaches.2
The current study used the infrastructure and methods of the Baltimore site of the Epidemiological Catchment Area Study (ECAS), which looked at the incidence of psychiatric disorders in 20,000 persons in five community samples.3 The initial evaluation occurred in 1981 and follow-up evaluations occurred in 1993 and 1996; there were no demographic differences between those who were followed up and those lost to follow-up. A structured diagnostic interview was used to detect psychiatric disorders and participants were asked a series of questions about migraines (core symptoms, associated symptoms, presence or absence of aura) in accordance with the International Headache Society diagnostic criteria. Those who reported migraines in 1981 were excluded. For others, incidence rates were calculated over the period of follow-up of those who subsequently reported migraines, with or without aura. Case-control analyses compared incident migraine headaches with the nonmigraine controls and odds ratios (ORs) were conducted to calculate risk estimates per demographic and psychopathological features.
There were 1343 individuals interviewed in the follow-up study, excluding 362 who had reported migraines in 1981 and another 215 who had incomplete information. There were 118 (8.8%) incident cases of migraines. Incident rates were higher in every age category (18-29, 30-44, older than 45). Women and participants in the 18-29 group had the highest rates of migraine without aura. Adjustments for demographic variables revealed no associations except with female sex (OR of 4.58) and the youngest age group (OR of 4.52). In cross-sectional analyses of psychiatric disorders and migraines, depression (OR of 3.14), and panic disorder (OR of 5.09) had the strongest associations. Logistic regression models estimated the OR for antecedent psychopathologic features as a risk factor for developing migraines—the only disorder with an increased OR was phobia (1.70).
COMMENT BY DONALD M. HILTY, MD
Female sex, depression, and younger age have been previously reported as risk factors for migraines. In this study, depression did not predict development of migraines, which Swartz and colleagues attribute to the diverse age of participants. It is possible that a common risk factor (e.g., serotonin dysregulation) causes emergence of both disorders at a similar time. With regard to clinical practice and psychotropic medication, tricyclics have been reported to prophylaxe against migraines in open and controlled trials, while serotonin reuptake inhibitors have been reported to both prophylaxe and worsen migraines in open trials; neither agent is considered to be a first-line treatment for prophylaxis of migraines.
References
1. Breslau N, et al. Joint 1994 Wolff Award Presentation: Migraine and major depression: A longitudinal study. Headache 1994;34:387-393.
2. Breslau N, et al. Headache and major depression: Is the association specific to migraine? Neurology 2000;54:308-313.
3. Regier DA, et al. The NIMH epidemiological catchment area program: Historical context, major objectives, and study population characteristics. Arch Gen Psychiatry 1984;41:934-941.