Psychiatric comorbidity in patients with migraine

INTRODUCTION

Migraine affects 12% of adults in the United States, making this condition a common concern for many patients and their doctors.¹ Often overlooked is the high prevalence of psychiatric comorbidities associated with migraine, such as depression, anxiety and post-traumatic stress disorder.^2-4 Migraine patients with psychiatric comorbidity have higher healthcare utilization than patients without psychiatric comorbidity.⁵

The aim of the present study was to study the demographic profile, clinical presentation and psychiatric comorbidity in patients suffering from migraine.

METHODS

Study design

The present study was a hospital based cross-sectional study.

Study participants and settings

A total of 90 patients were included in our study.

The study population consisted of all the patients of migraine who attended the department of psychiatry, Government Medical College, Srinagar over a period of 6 months from October 2021 to March 2022 who fulfilled the inclusion criteria of the study.

Inclusion criteria

Patients who gave consent, and subjects who fulfilled the diagnostic criteria of migraine as per ‘international classification of headache disorders^’- 3^rd edition (ICHD-3) were included in the study.⁶

Exclusion criteria

Patients who did not give consent, and subjects having cognitive deficit were excluded.

Data collection and statistical analysis

All the study subjects were thoroughly evaluated on the basis of history and mental status examination, and the comorbid psychiatric diagnosis was confirmed by a consultant psychiatrist as per DSM-5 diagnostic criteria.⁷

A semi-structured proforma was created to record demographic details and clinical presentation.

The data was entered into excel sheet and tabulated. The data was analyzed using statistical package for the social sciences (SPSS) version 20.0.

Categorical variables were summarized as frequency and percentage. Continuous variables were summarized as mean and standard deviation.

Ethical consideration

The study was approved by the institutional ethical committee of Government Medical College, Srinagar.

RESULTS

Demographic profile

Majority of our study population and were in the age range of group of 21-40 years (41.1%), females (83.3%), married (74.4%) and from urban background (57.8%). The mean age of study population was 28.46±8.76 years. 64.5% of patients were literate with a formal education above 10^th class. Most common occupational group was homemakers (52.2), followed by students (22.2%) (Table 1).

Clinical presentation

Migraine without aura was the most common type of migraine (65.6%). Majority of the patients would experience a frequency of 2-3 per week (37.8%) followed by 1-2 per week (26.7%). Most common precipitating factor was noise (75.6%), sunlight (65.6%) and sleep deprivation (25.6%).

More than one precipitating factors were noted in majority of the patients. Family history of migraine was present in 12.2% of patients (Table 2).

Psychiatric comorbidity

Anxiety disorders were the most common comorbid psychiatric disorder (40%), followed by major depressive disorder (24.4%). No psychiatric comorbidity was present in 24.6% of patients (Table 3).

DISCUSSION

Migraine is reported to be more common in persons between the age of 20 and 45 years.⁸ In the present study also, migraine was found to be more common among age group of 21-40 years (41.1%). Females were found to suffer more commonly than males (4:1) which is in consistent with other studies conducted across the world.^8,9 A study from Turkey shows that the female to male sex prevalence for migraine has consistently varied across the lifespan ranging from 3 or 4 to 1 in midlife and lowering to 2 to 1 or less at both ends of the age spectrum.¹⁰Although rates varies from different studies, the female preponderance in migraine is consistent throughout the world.¹¹

Majority of patients were married (76%) and this may be because of the age group commonly affected by migraine. Most of the patients were educated with a formal education above 10^th class (64.5%) which is in consistent with various studies conducted in India and across the world. According to a study done in the western country, migraine was more prevalent among people who have higher educational levels.¹² In another study, higher education was related to an increased risk of chronic headache.¹³ The studies in India also found higher rate of migraine in homemaker which is in accordance to our study.¹⁴

Migraine without aura was the commonest subtype seen in 65.6% of study population. This is consistent with the reported findings that lifetime prevalence of migraine without aura is about 13% as compared to migraine with aura seen in less than 4% population.¹⁵ The frequency of migraine commonly reported by patients was 2-3/week (37.8%) followed by 1-2/week (26.7%) which is in consistent with studies done in India.¹⁴

The precipitating factors of migraine were reported by majority of the patients. The most common precipitating factor was noise (75.6%), sunlight (65.6%) and sleep deprivation (25.6%). More than one precipitating factors was reported by majority of the patients. The other precipitating factors for migraine as reported in the literature e.g. aged cheeses, caffeine, chocolate, concentrated sugar, dairy products, fermented, pickled food, yeast products, meats with nitrites, monosodium glutamate, and saccharin could not be identified or reported by the patients in the present study.^15,16

Migraine was comorbid with psychiatric disorders in 75.4% of patients. Anxiety disorders (40%) were the most common psychiatric disorder followed by major depressive disorder (24.4%). The other comorbid psychiatric disorders were obsessive compulsive disorder (4.4%), substance use disorder (4.4%) and personality disorder (2.2%). Anxiety disorders are two to five times more prevalent in patients with migraine than in the general population, up to two times more common in patients with migraine than in patients with depression.² Among the anxiety disorders, generalised anxiety disorder (GAD) and panic disorder (PD), are the most strongly linked with migraine.¹⁷ Patients with GAD are at increased risk for migraine, and patients with migraine are at increased risk for GAD.¹⁸ Patients with obsessive compulsive disorder (OCD) are at increased risk and higher frequency of migraine.¹⁹ PD is associated with increased migraine frequency, increased disability, higher risk of chronification and higher risk of medication overuse.²⁰ Migraine and PD share features such as functional impairment, gastrointestinal (nausea), autonomic (dizziness), affective (fear) symptoms during attacks, and worry about further attacks between attacks.²⁰

Limitations

Being a hospital-based study; it has its limitations of not being representative of the whole community.

CONCLUSION

Migraine is consistently associated with several psychiatric disorders, including anxiety and depressive disorders. It is important to maintain diagnostic vigilance for comorbid conditions. When migraine and a comorbid psychiatric disorder are present, it is important to take both disorders into account in formulating a treatment plan.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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