Comorbidity of Migraine and Psychiatric Disorders
Comorbidity of Migraine and Psychiatric Disorders
Background: Migraine is common, with an estimated lifetime prevalence of 7-17%. Population-based studies have reported an association between various psychiatric conditions and migraine. This is a population-based study exploring the association between migraine and psychiatric disorders in a large cohort and assessing various health-related outcomes.
Objective: (1) Determine the prevalence of various psychiatric conditions in association with migraine; (2) describe the patterns of association of these comorbidities with a variety of health-related outcomes.
Methods: Data from the 2002 Canadian Community Health Survey were used. This is a national health survey which included administration of the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects. Health-related outcomes included 2-week disability, restriction of activities, quality-of-life, and mental health care utilization.
Results: The prevalence of physician-diagnosed migraine (n = 36,984) was 15.2% for females and 6.1% for males. Migraine was most common in those between ages 25 and 44 years and in those of lower income. Migraine was associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia, all occurring more than twice as often in those with migraines compared with those without. Migraine was not associated with drug, alcohol, or substance dependence. The higher prevalence of psychiatric disorders in migraineurs was not related to sociodemographic variables. Psychiatric disorders were less common in those over 65 years, in those who were in a relationship, and in those of higher income whether migraine was present or not. Health-related outcomes were worst in those with both migraines and a psychiatric disorder and intermediate in those with either condition alone.
Conclusion: Migraine is associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia. Migraine in association with various mental health disorders results in poorer health-related outcomes compared with migraine or a psychiatric condition alone. Understanding the psychiatric correlates of migraine is important in order to adequately manage this patient population and to guide public health policies regarding health services utilization and health-care costs.
Migraine is common, with a lifetime prevalence in Canada estimated to be around 7-17%, in keeping with findings from non-Canadian research. Studies consistently show that migraines are up to 4 times more common in women than men, and peak in incidence between ages 25 and 44 years. The World Health Organization (WHO) has identified primary headaches including migraines as a major public health problem due to their high prevalence, widespread age and geographic distribution, and their significant functional and socioeconomic impact.
In the 1970s, Feinstein coined the term comorbidity to refer to the "greater than coincidental association of two conditions in the same individual." Over the years, it has become apparent from population-based studies that various psychiatric conditions are associated with migraine. These include major depression, bipolar disorder, panic disorder, phobia, and substance dependence. The risk of suicide has also been found to be increased in patients with migraine. Understanding the psychiatric correlates of migraine is very important for many reasons. For instance, depressive disorders are one of the leading causes of disability worldwide and the WHO estimates that major depressive disorder (MDD) will become the second leading cause of disease burden worldwide by the year 2020, second only to ischemic heart disease. Furthermore, individuals with migraine and psychiatric comorbidities are greater health resource users than migraineurs without psychiatric conditions. Finally, recognizing psychiatric comorbidities in those with migraine should result in improvement in patient management, by alerting physicians that first-line treatment should be targeted at both conditions, ie, migraines and the associated mental health disorder.
Although various psychiatric conditions have been studied in migraine patients, this is the first comprehensive Canadian population-based study exploring the association between migraine and several comorbid psychiatric conditions in a large cohort. This study is also important for several other reasons: (1) it uses a fully structured, validated interview (face-to-face interviews in 86% of subjects) based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for the assessment of mental disorders; (2) it is the first ever national survey on mental health; (3) it is representative of the entire Canadian population (all provinces); (4) it uses a very large cohort (n = 36,984); it has a very good response rate (77%); and (5) it not only addresses the psychiatric comorbidities but also addresses medication use, quality-of-life, disability, and various other functional and socioeconomic variables. The primary objectives of this study were to (1) determine the prevalence of various psychiatric conditions in association with migraine in a large population sample; and (2) describe the pattern of association of this comorbidity with a variety of health-related outcomes.
Background: Migraine is common, with an estimated lifetime prevalence of 7-17%. Population-based studies have reported an association between various psychiatric conditions and migraine. This is a population-based study exploring the association between migraine and psychiatric disorders in a large cohort and assessing various health-related outcomes.
Objective: (1) Determine the prevalence of various psychiatric conditions in association with migraine; (2) describe the patterns of association of these comorbidities with a variety of health-related outcomes.
Methods: Data from the 2002 Canadian Community Health Survey were used. This is a national health survey which included administration of the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects. Health-related outcomes included 2-week disability, restriction of activities, quality-of-life, and mental health care utilization.
Results: The prevalence of physician-diagnosed migraine (n = 36,984) was 15.2% for females and 6.1% for males. Migraine was most common in those between ages 25 and 44 years and in those of lower income. Migraine was associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia, all occurring more than twice as often in those with migraines compared with those without. Migraine was not associated with drug, alcohol, or substance dependence. The higher prevalence of psychiatric disorders in migraineurs was not related to sociodemographic variables. Psychiatric disorders were less common in those over 65 years, in those who were in a relationship, and in those of higher income whether migraine was present or not. Health-related outcomes were worst in those with both migraines and a psychiatric disorder and intermediate in those with either condition alone.
Conclusion: Migraine is associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia. Migraine in association with various mental health disorders results in poorer health-related outcomes compared with migraine or a psychiatric condition alone. Understanding the psychiatric correlates of migraine is important in order to adequately manage this patient population and to guide public health policies regarding health services utilization and health-care costs.
Migraine is common, with a lifetime prevalence in Canada estimated to be around 7-17%, in keeping with findings from non-Canadian research. Studies consistently show that migraines are up to 4 times more common in women than men, and peak in incidence between ages 25 and 44 years. The World Health Organization (WHO) has identified primary headaches including migraines as a major public health problem due to their high prevalence, widespread age and geographic distribution, and their significant functional and socioeconomic impact.
In the 1970s, Feinstein coined the term comorbidity to refer to the "greater than coincidental association of two conditions in the same individual." Over the years, it has become apparent from population-based studies that various psychiatric conditions are associated with migraine. These include major depression, bipolar disorder, panic disorder, phobia, and substance dependence. The risk of suicide has also been found to be increased in patients with migraine. Understanding the psychiatric correlates of migraine is very important for many reasons. For instance, depressive disorders are one of the leading causes of disability worldwide and the WHO estimates that major depressive disorder (MDD) will become the second leading cause of disease burden worldwide by the year 2020, second only to ischemic heart disease. Furthermore, individuals with migraine and psychiatric comorbidities are greater health resource users than migraineurs without psychiatric conditions. Finally, recognizing psychiatric comorbidities in those with migraine should result in improvement in patient management, by alerting physicians that first-line treatment should be targeted at both conditions, ie, migraines and the associated mental health disorder.
Although various psychiatric conditions have been studied in migraine patients, this is the first comprehensive Canadian population-based study exploring the association between migraine and several comorbid psychiatric conditions in a large cohort. This study is also important for several other reasons: (1) it uses a fully structured, validated interview (face-to-face interviews in 86% of subjects) based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for the assessment of mental disorders; (2) it is the first ever national survey on mental health; (3) it is representative of the entire Canadian population (all provinces); (4) it uses a very large cohort (n = 36,984); it has a very good response rate (77%); and (5) it not only addresses the psychiatric comorbidities but also addresses medication use, quality-of-life, disability, and various other functional and socioeconomic variables. The primary objectives of this study were to (1) determine the prevalence of various psychiatric conditions in association with migraine in a large population sample; and (2) describe the pattern of association of this comorbidity with a variety of health-related outcomes.
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