Psychiatric comorbidities of migraine.

Migraine is commonly comorbid with psychiatric conditions, particularly major depressive disorder, anxiety disorders, and sleep disorders. The presence of psychiatric disorders can make diagnosis and treatment more challenging. Existing studies suggest that the relationship between migraine and psychiatric disorders is bidirectional, such that each disorder confers increased risk for onset of the other. Mechanisms underlying this comorbidity are largely speculative but include serotonergic dysfunction, medication overuse, allostatic load, and behavioral factors such as pain-related appraisals and unwarranted avoidance behaviors. Psychiatric comorbidities present unique clinical considerations for assessment and treatment, foremost among which is a need to routinely screen migraine patients for depression, anxiety, and insomnia. Common screening considerations and measures validated on headache patients are reviewed. Comprehensive treatment of migraine requires interventional attention also to any psychiatric comorbidities, though few randomized trials have rigorously evaluated the efficacy of pharmacologic or behavioral migraine interventions for comorbid psychiatric symptoms. Most modern antidepressants lack strong efficacy for migraine, and providers often utilize separate agents to treat migraine and any psychiatric comorbidities. Recent research on adjunctive behavioral interventions such as cognitive-behavioral therapy and acceptance-based approaches suggests they hold value in reducing psychiatric symptoms, though larger trials are needed.

The effect of the COVID-19 pandemic on headache-related disability among young adults with migraine.

OBJECTIVE: The present study aimed to explore the relationship between the COVID-19 pandemic and headache-related disability among a sample of young adults with migraine. BACKGROUND: Comorbid psychological symptoms compound migraine-related disability. Due to COVID-19 pandemic procedures, many students experienced institutional closures and corresponding increases in depression, stress, and anxiety. The present study sought to examine changes in headache-related disability before (Spring and Fall of 2019) and during (Fall of 2020 and Spring 2021) the COVID-19 pandemic and whether psychological symptoms mediated such changes. METHODS: A cross-sectional study at a southern U.S. university assessed 365 individuals with migraine on headache and psychological variables, comparing those surveyed before COVID-19 with another group surveyed during the pandemic. The direct and indirect effects of COVID-19 status (pre- versus during COVID-19) on headache-related disability through depression, anxiety, and stress symptoms were assessed. RESULTS: Statistically higher levels of depression, (M = 13.9 [SD = 12.2] vs. M = 8.7 [SD = 8.7], p < 0.001), anxiety (12.3 [10.0] vs. 9.7 [8.2], p = 0.01), and stress symptoms (17.6 [10.2] vs. 13.2 [7.9], p < 0.001) were endorsed during the COVID-19 pandemic. The direct path from COVID-19 status to headache-related disability was significant and negative, c' = -1.6 (95% CI: -3.1, -0.1). Anxiety (b = 0.3 [95% CI: 0.01, 0.9]) and depression (b = 0.7 [95% CI: 0.07, 1.4]) symptoms acted as mediators of this relationship, rendering the total effect nonsignificant and negating the lowered disability observed during the pandemic. Only depression symptoms remained a significant mediator after controlling for headache frequency (b = 0.7 [95% CI: 0.09, 1.4]). CONCLUSIONS: Increased depression and anxiety symptoms attenuated the improvements in disability associated with the pandemic. As such, interventions that address comorbid psychological symptoms may hold value in reducing headache-related disability and improving outcomes for young adults whose headache developed or worsened during the COVID-19 pandemic.