Knowledge About Comorbidities in Migraine

Many individuals with migraines report comorbidities—additional conditions or so-called dual or multiple diagnoses, such as depression, anxiety disorders, or vascular diseases.

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Last updated: March 4, 2024

True to the saying, “When it rains, it pours,” many migraine sufferers experience additional conditions, known as dual or multiple diagnoses or comorbidities. Migraine comorbidities refer to one or more diagnostically distinct conditions that can occur alongside the primary condition (in this case, migraine).

For example, I’ve been diagnosed with comorbidities such as depression related to migraines and a cerebral aneurysm (an abnormal widening of a brain artery). These comorbidities are common among migraine sufferers. Migraines are often accompanied by physical issues like vascular diseases such as hypertension or coronary artery disease and chronic pain syndromes like persistent back pain. Psychologically, depression and anxiety disorders top the list of migraine comorbidities.

Why Is Understanding Comorbidities Important for My Migraine Treatment?

Knowing your migraine comorbidities can guide the choice of medications for acute migraine attacks and preventive treatments. In my case, I was advised to avoid painkillers like ibuprofen and acetaminophen due to my aneurysm and instead use aspirin for acute therapy.

In the best-case scenario, a single medication might treat two conditions simultaneously. For instance, if a person with migraines also has depression, an antidepressant that works as an effective migraine prophylaxis could address both issues. Similarly, if someone has migraines and hypertension, beta blockers might be the preferred preventive medication, as they lower blood pressure and reduce migraine attacks.

Conversely, there are cases where treatments for one condition may worsen another. For example, beta blockers are typically avoided if both migraines and depression are diagnosed, as they can reduce motivation and exacerbate depressive symptoms. In such instances, your doctor will recommend an alternative treatment plan.

Who Can Assist with Diagnosing Conditions?

The first step is often visiting your primary care physician, who can diagnose your underlying condition and comorbidities. However, specialized knowledge is sometimes required, which might lead to a referral to a specialist. You can also directly consult a neurologist familiar with migraines, who may be better equipped to identify potential comorbidities.

That said, it’s frequently reported that migraine sufferers are not taken seriously and may receive incorrect diagnoses such as “tension headaches,” along with advice to “just relax” or prescriptions for physiotherapy. These misdiagnoses can lead to inappropriate treatments, potentially worsening the conditions.

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Is There a Connection Between Migraines and Comorbidities?

Some underlying conditions and their comorbidities share common pathophysiological mechanisms, such as migraines and depression. Hormones like serotonin or female sex hormones may play a central role in both conditions. Additionally, severe migraines can trigger depression and anxiety disorders. Chronic pain can lead to anxiety and panic about future attacks, as well as significant stress due to the social and professional setbacks caused by persistent discomfort. Thus, one condition can exacerbate the other.

Research in recent years has also established a link between migraines and an increased risk of stroke, particularly in migraines with aura, young women taking oral contraceptives, and smokers. Although the underlying mechanisms remain unclear, migraines with aura have been associated with circulating coagulation factors and vascular dysfunction.

In my case, my aneurysm may be an example of another phenomenon: chronic illnesses often lead to more frequent and detailed medical examinations. This increases the likelihood of diagnosing conditions that might otherwise have gone undetected, such as my aneurysm. I’ve heard of other migraine patients who underwent MRIs to investigate their chronic migraines and were incidentally found to have aneurysms. These incidental findings are not causally related to migraines.

Common Comorbidities in Migraine

Hypertension
Stroke
Coronary artery disease
Depression (and migraines)
Anxiety disorders
Post-traumatic stress disorder (PTSD)
Sleep disorders
Other pain conditions such as chronic back and neck pain, tension headaches, and fibromyalgia
Vestibular disorders such as vertigo, Ménière’s disease, and tinnitus
Other conditions including epilepsy, restless leg syndrome, thyroid disorders, obesity, and gastrointestinal conditions like irritable bowel syndrome (and migraines)

How Can Ebby Help?

The Ebby migraine app includes a headache diary to track your migraines, symptoms, and medications. It also allows you to monitor your sleep quality. You can share the logged data with your healthcare provider through a monthly report, giving them a clearer picture of the frequency of your migraines, associated symptoms, and your sleep patterns. This information can aid in treating migraines and provide insights into potential comorbidities.

The app also focuses on introducing a low-glycemic diet, which helps stabilize blood sugar levels and effectively prevents migraine attacks.

Conclusion

Migraine patients often face numerous comorbidities, including depression, anxiety disorders, hypertension, coronary artery disease, irritable bowel syndrome, and various chronic pain syndromes. Understanding these accompanying conditions is crucial for effective migraine therapy. It not only aids in selecting suitable medications but also opens opportunities to address multiple conditions with a single treatment when appropriate.

Therefore, understanding an individual’s unique issues, including other illnesses, is essential for developing a comprehensive treatment plan. The Ebby app offers a non-pharmaceutical approach to migraine prevention, potentially reducing migraines and positively influencing comorbidities.

Sources

Kaspar, U. Komorbidität und Migräne – www.headache.ch. https://www.headache.ch/Komorbiditaet_Und_Migraene.
Müller, D., Diener, H. C., Fritsche, G., Huhn, J.-I. & Rabe, K. F. Komorbiditäten der Migräne: praktische Behandlungskonsequenzen. Aktuelle Neurol. 40, 213–223 (2013).
Zhang, Q., Shao, A., Jiang, Z., Tsai, H. & Liu, W. The exploration of mechanisms of comorbidity between migraine and depression. J. Cell. Mol. Med. 23, 4505–4513 (2019).
Minen, M. T. et al. Migraine and its psychiatric comorbidities. J. Neurol. Neurosurg. Psychiatry 87, 741–749 (2016).
Øie, L. R., Kurth, T., Gulati, S. & Dodick, D. W. Migraine and risk of stroke. J. Neurol. Neurosurg. Psychiatry 91, 593–604 (2020).

About the Author

Miriam Jansen

Miriam had to give up her job due to chronic migraines - and became a migraine expert during this time. The migraine helped her to make a radical change in her life: She now lives as a digital nomad in her bus and works as a copywriter & as a shepherdess on an alp.