The associations between migraine, unipolar psychiatric comorbidities, and stress-related disorders and the role of estrogen.

Migraine is a common and often disabling neurovascular disorder. It has been linked with several psychiatric disorders, such as depression and anxiety, and to stress-related disorders, such as abuse and posttraumatic stress disorder (PTSD). Epidemiological data have consistently shown a higher prevalence of migraine, depression, anxiety, abuse, and PTSD in women as compared with men. The increased vulnerability of women to migraine and psychiatric disorders often occurs during periods of marked hormonal fluctuations of ovarian hormones. One consequence of these associations is the hypothesis that estrogens have a role in the pathophysiology of both disorders. This article offers an in-depth review of several studies linking psychiatric disorders and stress-related disorders with migraine. We also discuss the role of estrogen in the pathophysiologic overlap between these disorders. Finally, we briefly touch on where future research may be headed, in light of these data.

Self-reported vs measured body mass indices in migraineurs.

OBJECTIVE: To compare and contrast body mass indices calculated based on self-reported height and weight as compared with measured height and weight in migraine patients. BACKGROUND: Obesity is a risk factor for multiple neurological disorders including stroke, dementia, and migraine chronification. In addition, several cytokines and adipocytokines associated with migraine are modulated by body mass. The body mass index (BMI) is a commonly used anthropometric measure to estimate total body fat and is often calculated based on patient's self-reported height and weight. METHODS: This was a retrospective study evaluating consecutive migraine patients presenting to a headache clinic.Demographic characteristics and self-reported height and weight were obtained from a standardized questionnaire that each new patient completes upon presentation to the clinic. In addition, as depression has been shown to be associated with both migraine and obesity, information in regards to major depression utilizing the Patient Healthcare Questionnaire-9 was extracted as well. Following completion of the questionnaire, body mass indices are routinely measured, with height measured to the nearest 0.5 inch utilizing a mounted stadiometer, and weight measured with a standard scale to the nearest 0.5 lb. After this information was extracted from the charts, BMI was then calculated for both self-reported and measured body mass indices.Using the measured body mass indices as a standard, this was then compared and contrasted to the patient's self-reported body mass indices. RESULTS: A total of 110 patients were included in the study. Patients were predominantly female (91%) with a mean age of 38.6 +/- 11.6 years. Of the total patients included, no significant difference in self-reported height (mean 64.7 +/- 3.1 inches) as compared with measured height (mean 64.5 +/- 3.4 inches) was seen, P = .463. However, self-reported weight (169 +/- 41.3) was underestimated as compared with the measured weight (173.5 +/- 43.2), P = .001. And, the self-reported BMI (28.4 +/- 6.8) was significantly less than the measured BMI (29.4 +/- 7.5), P < .001. CONCLUSIONS: In our study, the self-reported mean weight and BMI for migraineurs was significantly less than the measured mean weight and BMI, and was of greater magnitude in the obese migraineurs. This suggests that conclusions drawn from studies evaluating obesity utilizing self-reported BMI in migraineurs may undercall the effect of total body obesity.