Migraines can be unpredictable and debilitating when they strike. They can have a major impact on all important areas of a patient’s life, according to Dawn Buse, PhD, a licensed psychologist and fellow with the American Headache Society, as well as a clinical professor at Albert Einstein College of Medicine of Yeshiva University.
Therefore, she says, it’s no surprise that people who suffer from migraines can experience feelings of sadness, frustration, guilt, embarrassment, anger and loss, to name a few, in response to their disorder.
Buse says physicians need to be sensitive to these emotional aspects of migraine disorder, which is a chronic disease that is often comorbid with other psychiatric conditions including depression, anxiety disorders, bipolar disorder, post-traumatic stress disorder, and personality disorders (see Figure above; please click on image to enlarge).
“Persons with migraine and at least one psychiatric comorbidity have worse health related quality of life than those having either disease alone,” Buse explains.
The risk of these psychiatric comorbidities increases the more frequently a person gets migraines, she says. “[They are] highest among people with chronic migraine compared with people with episodic migraine—often doubling,” Buse says.
And when it comes to migraine and depression, Buse says they are “bidirectional,” meaning each condition increases the risk of the other, for reasons that aren’t clear yet, but may include, “latent brain state models, shared environment, and shared genetic predisposition,” she says.
Smitherman TA, Baskin SM. Depression and Anxiety in Migraine Patients. American Migraine Foundation. https://americanmigrainefoundation.org/resource-library/depression-and-anxiety-in-migraine-patients/. Accessed May 13, 2019.