Migraine, mental disorders have bidirectional relationship

Migraine has a bidirectional relationship with mental disorders such as anxiety and depression, and one may increase the risk of the other, researchers reported in Cureus.

“Psychiatric disorders related to migraine include anxiety disorders, panic disorder, bipolar disorder, depression, etc.,” Ayushi S. Dhengare, MPH, and Darshna G. Fulmali, both of Jawaharlal Nehru Medical College in Wardha, India, wrote. “It is also estimated that people suffering from migraine are about five times more likely to develop depression than others without migraine.”

According to Dhengare and Fulmali, due to the same clinical characteristics of migraine and mental disorders, such as depression, anxiety, mood swings and bipolar disorder, the two are “inextricably linked.” Those with a migraine disorder are more prone to anxiety disorders, compared with the general population.

“Psychiatric illnesses and migraine have a bidirectional relation, with one condition raising the risk of others,” the authors wrote. “Clinical and epidemiological investigations have both provided a correlation between this disease and psychological issues. The anxiety disorder clinic sample seemed to have a 67% probability of migraine.”

Clinical features of migraine are observed as episodic headaches marked by pain felt on one side of the head, the researchers wrote. Patients with migraine, especially those with chronic migraine, have a higher probability of undergoing extreme anxiety and suicidal tendencies.

“Both migraines and depression exhibit bidirectional relations, with one increasing the risk of developing the other. In most cases, depression develops after the beginning of a major headache disorder, therefore this bidirectional association appears to be specific to migraine,” the authors wrote.

Migraine can be stimulated by stress, lack of sleep, missing meals or fasting, high intensity of light, noise or smell, the researchers reported. A headache in migraine is resistant to medical treatment but “responds well” to botulinum toxin, or Botox (Allergan).

While botulinum toxin A and botulinum toxin B have both shown to be effective, botulinum toxin A (BoNT-A) is more extensively utilized, due to its least noticeable side effects and prolonged durability, the authors wrote.

According to the study, BoNT-A has been used for more than 15 years for the management of chronic migraine headaches and has recently emerged as a safe alternative for preventing persistent migraine.

“Botulinum toxin is a neurotoxin that is produced by the bacteria Clostridium botulinum. Botulinum toxin is generally used in the form of injections. It is well [tolerated] and has few or relatively minimum side effects,” the researchers wrote. “It not only helps in migraine but is also beneficial for addressing a broad range of involuntary muscular contraction diseases such as cervical dystonia, hemifacial spasm and blepharospasm.”

The FDA authorized the use of botulinum toxin as a prophylactic treatment for chronic migraine in 2010. Those who received botulinum toxin for chronic migraine observed benefits in their signs, symptoms and quality of life.

“The recent advancement in treating migraine and the associated neuropathic pain with botulinum toxin has come up, benefiting a large population of sufferers,” the authors wrote. “Still, the full potential of this toxin is undiscovered and needs more research.”