Psychiatric comorbidity in migraine

Abstract

Although migraines and psychiatric disorders are very common, literature on their comorbidity is quite scant. A high incidence of migraine has been detected in patients with anxiety and bipolar disorders, but most data are found on the comorbidity of migraine and depressive disorders. They are connected through a common etiology, i.e., genetic predisposition, serotonin system disorders, and similar psychological factors. It is not surprising that some antidepressants have exhibited a beneficial effect in both disorders, mainly amitriptyline, duloxetine and venlafaxine, and possibly mirtazapine and agomelatine. Because some antimigraine drugs and many antidepressants affect specific components of the serotonin system, interactions are possible and thus necessary precautions must be taken. Psychotherapy also has a direct effect on the migraine as well as symptoms of depression and anxiety. Valproate was reported to improve symptoms of both migraine and bipolar disorder. Psychiatric comorbidity in migraine patients is still incompletely understood, and some authors even recommend routine screening of patients with migraines for symptoms of psychiatric disorders, especially depression and anxiety. Both disorders need to be treated simultaneously. Therefore, the cooperation between neurologist and psychiatrist is the key to achieving the best results.