We've known for some time now that Migraine disease and major depressive disorder (MDD) tend to be comorbid conditions. That means that we frequently see people who have both simultaneously, but neither condition causes the other. Now, research is showing a similar connection to post-traumatic stress disorder (PTSD).
The objective of a new study by Peterlin et. al. was:
"To evaluate the relative frequency of posttraumatic stress disorder (PTSD) in episodic migraine (EM) and chronic daily headache (CDH) sufferers and the impact on headache-related disability."1
The prevalence of PTSD in the general population is estimated to be 8%. Two earlier studies have looked at PTSD in patients with headache disorders. One study seemed to show that Migraine and headache patients have a higher risk of developing PTSD than those without the disorders. Unfortunately, Migraineurs and tension-type headache patients were studied together in one group and compared to patients with pain unrelated to headache disorders. Thus, it was impossible to draw information specific to Migraine from the study. A second study might have shown PTSD as a risk factor for Migraine advancing from episodic to chronic. However it was a very small study group, and assessment of depression was self-reported by the patients and not clinically verified.
- The study was conducted with patients from six Migraine and headache treatment centers.
- All study participants were examined by a Migraine and headache specialist.
- Patients were recruited in the age group of 18 to 65.
- Headache disorder diagnoses were classified in accordance with the International Headache Society's International Classification of Headache Disorders, Second Edition (ICHD-II).
- Analysis included 593 patients who fulfilled the criteria for episodic Migraine (EM) or chronic daily headache (CDH).
- PTSD was diagnosed in 30.3% of the participants with CDH.
- PTSD was diagnosed in 22.4% of the participants with Migraine.
- Participants with both major depressive disorder and PTSD were more likely to have CDH (24.6% of participants) than EM (15.79%).
- Disability was greater in participants with EM and PTSD.
- "The frequency of PTSD in Migraineurs, whether episodic or chronic, is higher than the historically reported prevalence of PTSD in the general population.
- In addition, in the subset of Migraineurs with depression, PTSD frequency is greater in CDH sufferers than in episodic Migraineurs.
- Finally, the presence of PTSD is independently associated with greater headache-related disability in Migraineurs."
Study author comments:
"Despite the clinical perception that military combat is the most common (cause), the most common causes of PTSD are interpersonal traumas, including sexual abuse... In women, the lifetime prevalence of PTSD is twice that of men... The implications are such that abuse causes not just psychological distress from PTSD but also physical pain such as migraine, and there is an increased disability seen in those migraine sufferers with PTSD than those without PTSD." ~~B. Lee Peterlin, DO3
"Pharmacologically, dual action antidepressants have efficacy for both migraine and PTSD, but the serotonin-reuptake inhibitor antidepressants regarded as first-line treatments for PTSD have performed poorly for migraine prophylaxis." ~~Dr. James L. Griffith2, 3
Summary and comments:
The data from this study clearly establishes that PTSD is more common among those with Migraine and chronic daily headache. Dr. Griffith's comments in his research commentary are well placed. There are significant treatment implications to the increased prevalence of PTSD in those with Migraine and chronic daily headache. Some Migraine and headache specialists are now leaning more toward SNRI antidepressants that affect both serotonin and norepinephrine than the SSRI antidepressants that affect serotonin only. The SNRIs are working quite well for Migraine and headache prevention in some patients.
Hopefully, more research will be forthcoming about the connections between Migraine and major depressive disorder, and PTSD, and other mental health issues. The development of additional treatments that could be used to treat both headache disorders and mental health disorders could be quite beneficial.
1 B. Lee Peterlin, DO; Gretchen E. Tietjen, MD; Jan L. Brandes, MD; Susan M. Rubin, MD; Ellen Drexler, MD; Jeffrey R. Lidicker, MSc; Sarah Meng, DO. "Posttraumatic Stress Disorder in Migraine." Headache 2009;49:541-551.
2 James L. Griffith, MD. "Posttraumatic Stress Disorder in Headache Patients: Implications for Treatment." Headache 2009;49:554-554.
3 Rauscher, Megan. "Post-traumatic stress common in migraine sufferers." Reuters. April 3, 2009.