Look for link to mental illness, abuse in choosing migraine care

Research suggests that unless these conditions are addressed, headaches will not get better.

By Victoria Stagg Elliott, AMNews staff. July 2, 2007.

The detection of mental illness and previous physical, emotional or sexual abuse is crucial to choosing effective treatment strategies for patients with migraines and other forms of severe headaches, said several presenters at the American Headache Society meeting in Chicago in June.

"These patients, for whatever reason, just don't seem to do as well," said Gretchen Tietjen, MD, lead author of a paper finding a high prevalence of depression among women with migraines who had some form of emotional abuse. "Maybe they need higher doses of medication or different approaches." She is also professor and chair of the Neurology Dept. at the University of Toledo in Ohio.

It has long been recognized that migraineurs have a rate of psychiatric illness higher than that of the general population, and research at this meeting further confirmed this concept. One study concluded that 8.6% of patients presenting to a headache clinic for migraine treatment also had bipolar spectrum disorder. This condition also was noted in 6.6% of those with cluster headache and 4.5% of those with chronic tension headaches.

Previous studies have suggested that this disorder has a prevalence in the general population of 1% to 3%. Experts said this condition, in particular, was important to recognize in those receiving headache treatment because antidepressants are sometimes used for this purpose. These drugs are not recommended for patients who are bipolar.