Migraine and Anxiety Disorders
Anxiety disorders are also associated with migraine. This relationship has been observed in both clinic and community-based populations. Herein, we summarize 2 large scale, prospective community studies that have demonstrated a cross-sectional relationship between migraine and various anxiety disorders.
The study reported by McWilliams et al showed a link between migraine and depression (see above), as also between migraine and anxiety. In this study, 9.1% of subjects with migraine, compared with only 2.5% of people without migraine had comorbid generalized anxiety disorder (OR 3.9, 95% CI 2.5 to 6.0). The association remained significant, even after adjusting for demographic variables including other common pain conditions (arthritis and back pain).
Another study reported that the association between migraine and anxiety disorders was even stronger than that for the affective disorders. In this prospective study among young adults, general anxiety disorder (OR 5.3, 95% CI 1.8 to 15.8) and social phobia (OR 3.4, 95% CI 1.1 to 10.9) were the types of anxiety disorders that exhibited the greatest association with migraine. Although the phobias were generally associated with migraine, agoraphobia did not show this relationship. This may be explained by the rarity of the disease.
The relationship between migraine and panic disorder has also been reported, but the temporal relationship between the 2 disorders has not been thoroughly explored. One recent study examined the panic disorder-migraine association in a population-based survey in the Detroit, MI area. In this study, the OR of panic disorder associated with migraine, adjusted for history of major depression and sex, was 3.7 (95% CI 2.2 to 6.2). Similarly, the OR for panic disorder associated with severe headache, adjusted for major depression and sex, was 3.0 (95% CI 1.5 to 5.8).
Using a Cox proportional hazards model, and controlling for history of major depression and sex, the investigators examined the temporal relationships between migraine and panic disorder, and also severe headache and panic disorder. The adjusted HR for the first onset of panic disorder among migraineurs was 3.6 (95% CI 2.2 to 5.8), and among severe headache patients was 5.8 (95% CI 2.7 to 12.3). The depression and sex-adjusted HR for first onset of migraine in people with prior panic disorder was 2.1 (95% CI 1.4 to 3.1). Similarly, the HR for the first occurrence of severe headache associated with prior panic disorder was 1.9 (95% CI 0.7, 4.8). The results of this study indicate that the comorbidity of panic disorder is not specific to migraine, but includes other headache types as well. The investigation of the temporal relationship between the disorders suggests that the influence appears to be in the headache-to-panic disorder direction, rather than the reverse.
Sandra W. Hamelsky, PhD, MPH, The Bradstreet Group, 1588 Route 130 North, North Brunswick, NJ 08902, USA
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (Drs. Hamelsky and Lipton); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (Dr. Hamelsky); and Montefiore Headache Center, New York, NY, USA (Dr. Lipton).
Headache. 2006;46(9):1327-1333.
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