The Interconnected Reality of Neurologic and Psychiatric Disorders in Migraine: Andrea S. Synowiec, DO, FAAN


The system vice chair for the department of neurology at Allegheny Health Network talked about the growing evidence emphasizing the need for a more holistic approach to patient care in migraine. [WATCH TIME: 4 minutes]

WATCH TIME: 4 minutes

"The scientific basis of seeing the relationship between neurologic and psychiatric disorders is gratifying. My hope is that as the culture becomes more aware and less discriminating, the line between them becomes less strict. I think sometimes patients will come into the clinic with neurologic problem, and they'll also need a psychiatric evaluation or care as well. "

In medicine, neuropsychiatry is at the crossroads of neurology and psychiatry, dealing with the interface of behavioral phenomena driven by brain dysfunction. In neurological conditions, psychiatric symptoms may be highly prevalent and contribute as a major source of disability and diminished quality of life.1 One neurological condition that has been associated with several psychiatric disorders such as depression and anxiety is migraine, a common and often disabling neurovascular disorder.2

According to a review previously published in the French medical journal Revue Neurologique, research shows that psychiatric comorbidity is more frequent among patients with chronic migraine than in those with episodic migraine.3 The method for how to treat patients with migraine who have a psychiatric comorbidity, especially those that frequently experience severe migraine or refractory migraine, is a high consideration for clinicians in the field. Although antidepressant and anticonvulsive treatments, as well as psychological therapies, might be useful for these patients, researchers recommend an integration of a multidisciplinary approach to care.3

Andrea S. Synowiec, DO, FAAN, the system vice chair for the department of neurology at Allegheny Health Network, recently sat down in an interview with NeurologyLive® to discuss how the growing scientific evidence of the interconnectedness of neurologic and psychiatric disorders can reshape the cultural perception and treatment approaches. Synowiec, who is also an associate professor of neurology at Drexel University, talked about the novel mechanisms in drug development that are expected to potentially revolutionize migraine treatment beyond anti-calcitonin gene-related peptide inhibitors. In addition, she spoke about how the research on olanzapine's role in status migrainosus management contributes to the exploration of alternative and effective treatment options.

1. Lyketsos CG, Kozauer N, Rabins PV. Psychiatric manifestations of neurologic disease: where are we headed?. Dialogues Clin Neurosci. 2007;9(2):111-124. doi:10.31887/DCNS.2007.9.2/clyketsos
2. Peterlin BL, Katsnelson MJ, Calhoun AH. The associations between migraine, unipolar psychiatric comorbidities, and stress-related disorders and the role of estrogen. Curr Pain Headache Rep. 2009;13(5):404-412. doi:10.1007/s11916-009-0066-1
3. Radat F. What is the link between migraine and psychiatric disorders? From epidemiology to therapeutics. Rev Neurol (Paris). 2021;177(7):821-826. doi:10.1016/j.neurol.2021.07.007
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