Significant Correlations Identified Between Mental Health and Migraine

Larry Newman, MD

Recently announced findings from the Migraine and Mental Health Connection Survey showed that a majority of healthcare professionals and patients with migraine believe that migraine and mental health significantly impact each other, adding that stigma remains a major issue for patients looking to further discuss their mental state.¹

The study, a collaboration effort between the American Migraine Foundation (AMF) and Biohaven Pharmaceuticals, fielded responses from 1100 people with migraine and a mental health condition, and 302 HCPs that treat neurological diseases. Findings showed that 91% of HCPs and two-thirds (67%) of patients with migraine believed that better migraine management comes hand-in-hand with better overall control of stress and mental health.

"Migraine is complex and has the capacity to disrupt a person's life, relationships and sense of well-being, which in turn can impact their mental health,” Judy Ho, PhD, forensic neuropsychologist, and associate professor, Pepperdine University, said in a statement.¹ "The Migraine and Mental Health Connection Survey showed that people with migraine and healthcare professionals are aligned in recognizing that the unpredictable and disabling nature of migraine attacks often creates worry and anxiety that can add difficulty to one's ability to manage migraine and further impact their mental health."

She added, "This is often referred to as a ‘vicious cycle’ between migraine and mental health. It's important that people with migraine understand that improving mental health can lead to better migraine outcomes, and vice versa."

While two-thirds of patients believed it was important to discuss mental health with their HCP, 60% of patients raised the conversation themselves, even though most wished their HCP would initiate the conversation. Contrary to those thoughts, 70% of HCPs reported that they ask about mental health conditions frequently, if not always. Findings also suggested that HCPs underestimate the number of patients with migraine who have either anxiety or depression. Although 50% and 57% reported a diagnosis of anxiety or depressive disorder, HCPs estimated that these conditions occur in just 29% and 30% of patients, respectively.

In a conversation with NeurologyLive^®, Lawrence Newman, MD, chair of AMF, noted that some of the discrepancies in conversations about mental health could be driven by hesitation around which specialist—migraine or mental health—is optimal to speak to about these issues. “I was struggling with that when looking at the results. I think that the patient is very savvy, and they know that they're going to see a doctor, and the doctor is going to give them 15 minutes. They're thinking, ‘How am I going get the best bang for my buck out of this out of this visit? If I go on a tangent, am I not going to get the treatment that I need for my migraine? Or, if I go on another tangent, I'm not going to get treatment for my mental health.’ They're playing this game, and they're pretty much stuck between a rock and a hard place. In many instances, they want help, but they don't know where to go,” he explained.

Newman added that, as a headache specialist, he has a luxury of time for patient visits that other physicians who treat patients with migraine may not. For those clinicians who have it, making that time for these individuals to discuss their mental health can be an important part of uncovering challenges that they’re facing. “Part of it is that the patient relaxes when they when you ask them proactively about their anxiety or their depression. It's like this light bulb goes off when you tell them, ‘I'm not surprised that you have depression,’ or, ‘I'm not that surprised that you also have an anxiety disorder.’ Because they're comorbid—they go together more often than you'd expect by chance. It kind of lets them sit back and relax and realize that I'm not there just to get three pieces of information, write a prescription, and get them out of the door," he told NeurologyLive^®.

The overwhelming majority of both patients with migraine (87%) and HCPs (94%) reported that mental health would benefit from improved migraine control. Medication (83%), followed by psychotherapy or cognitive behavioral therapy (71%) and relaxation therapy (70%) accounted for the top recommended mental health treatments by HCPs. Despite these recommendations, only 58%, 28%, and 26% of patients reported using the techniques as frequently, respectively. Nearly all HCPs (91%) and over half of the patients with migraine (54%) felt that migraine management needs to be more flexible by tailoring treatment to patient needs.

"Closing the gaps in communication between healthcare professionals and their patients can help improve migraine and mental health management,” Newman said in a statement.¹ "I hope that the findings of this survey encourage people with migraine to feel empowered to speak out about their pain and have deeper, meaningful conversations about migraine and mental health without worrying about stigma. These are important conversations that both people with migraine and healthcare professionals should initiate at every visit."

The link between migraine and mental health has been previously documented before, even in pediatric populations. Findings from the Canadian Community Health Survey, a cross-sectional health survey sampling 61,375 participants, further explained this connection.2 Using the Composite International Diagnostic Interview-Short Form depression scale, the odds of migraine were higher among those with mood disorders, with the strongest association in 2011-2012 (adjusted odds ratio [aOR], 4.59; 95% CI, 3.44-6.12) and the weakest in 2009-2010 (aOR, 3.06; 95% CI, 2.06-4.55). The inverse association between high perceived mental health and the odds of migraine were observed in all cycles, with the strongest association in 2011-2012 (aOR, 0.58; 95% CI, 0.48-0.69) and the weakest in 2003-2004 (aOR, 0.75; 95% CI, 0.62-0.91).2

That study was led by Serena L. Orr, who recently appeared as a special guest in a NeurologyLive^® Mind Moments podcast to discuss a more recent work she’s done into mental health conditions among pediatric patients with migraine. Click the link below to hear the pediatric neurologist and headache specialist at the University of Calgary and Alberta Children’s Hospital provide additional background on how the field has progressed in managing the disease and advocating for these individuals.

REFERENCES
1. American Migraine Foundation survey shows nearly all people with migraine and healthcare professionals believe migraine and mental health significantly impact each other. News release. July 28, 2022. Accessed August 1, 2022. https://www.prnewswire.com/news-releases/american-migraine-foundation-survey-shows-nearly-all-people-with-migraine-and-healthcare-professionals-believe-migraine-and-mental-health-significantly-impact-each-other-301594846.html
2. Orr SL, Potter BK, Ma J, Colman I. Migraine and mental health in a population-based sample of adolescents. Can J Neurol Sci. 2017;44(1):44-50. Doi:10.1017/cjn.2016.402.