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Understanding migraine and psychiatric comorbidity

Seng, Elizabeth K.; Seng, Cynthia D.

Current Opinion in Neurology: June 2016 - Volume 29 - Issue 3 - p 309–313
doi: 10.1097/WCO.0000000000000309
HEADACHE: Edited by Peter J. Goadsby

Purpose of review: This article describes recent trends in our understanding of the role of psychiatric disorders in the experience and treatment of migraine, and the role of migraine in the experience and treatment of psychiatric disorders.

Recent findings: Although the majority of studies evaluating psychiatric comorbidity in migraine have focused on depression, anxiety, and bipolar disorders are highly associated with migraine and relevant for prognosis and treatment planning. Comorbid psychiatric disorders may be associated with poorer treatment response for some acute pharmacotherapies; however, people with comorbid migraine and mood or anxiety disorders can achieve large responses to preventive pharmacologic and behavioral therapies. Emerging research is developing and evaluating behavioral treatments designed to manage cooccurring migraine and mood or anxiety disorders. Stigma related to psychiatric disorders has been well characterized, and could exacerbate extant migraine-related stigma.

Summary: Anxiety and mood disorders are prevalent in people with migraine, although not ubiquitous. Psychiatric comorbidity is associated with greater migraine symptoms and disability; however, people with comorbid depression or anxiety are amenable to preventive migraine treatment. Research regarding migraine treatment strategies optimized for people with comorbid psychiatric disorders is critical to advancing care and reducing stigma for this important subpopulation of people with migraine.

aSaul R. Korey Department of Neurology, Albert Einstein College of Medicine, Ferkauf Graduate School of Psychology, Yeshiva University, New York City, New York

bNeurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Correspondence to Elizabeth K. Seng, PhD, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, Bronx, NY 10461, USA. Tel: +1 718 430 3813; e-mail: Elizabeth.Seng@einstein.yu.edu

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