New Migraine Links to Depression and Anxiety

Migraine has long been associated with psychiatric disorders, and the relationship remains of growing interest to clinicians. Some very recent research findings have added to the literature on the associations between migraine and depression, anxiety, and other disorders. Following are highlights:

• Migraine predicts physical symptoms: Migraine and anxiety disorders negatively affect painful physical symptoms (PPS) in patients with major depressive disorder (MDD). Study patients with migraine had a greater severity of PPS at baseline and post-treatment than those without. Migraine predicted poorer treatment responses of chest pain and full remission of pains in the head, chest, neck, and shoulder; anxiety disorders predicted less full remission of pains in the abdomen and limbs. Integrating migraine and anxiety disorders management with that of depression might improve PPS and MDD prognosis.

• Anxiety sensitivity, pain, and headache, oh my: Anxiety sensitivity-the fear of arousal-related bodily sensations resulting from beliefs about presumed harmful consequences-predicts pain itself, adjustment to pain, and evaluation of factors that influence pain in patients with primary headache. This fear reliably differentiated study patients who had headache from those who did not; it was highest among chronic migraineurs and episodic migraineurs with aura. AS accounted for 8.4% of variance in headache symptomatology and was most strongly associated with prototypical migraine symptoms. It predicted headache-related disability and trigger variables, even after controlling for frequency and severity.

• Migraine tied to hormones, stress: In women, migraine, particularly without aura, is mainly associated with stress-related anxiety or depression. Women are more vulnerable to stress and to migraine than men and are more susceptible to stress in the premenstrual period. Significantly higher values of prolactin were observed in study cases than in controls. There was no statistically significant difference in levels of thyroid-stimulating hormone, estrogen, luteinizing hormone, or follicle-stimulating hormone.

• Migraine hurts hearing sense: In a study of central auditory processing, patients who had migraine with aura and without aura performed more poorly than controls. They had an inferior performance in auditory gap detection and in the discrimination of short and long durations. They presented impairment in the physiological mechanism of temporal processing, especially in temporal resolution and temporal ordering. The difficulties could reflect on auditory memory and attention deficits.

• Breast cancer risk-migraine history link: The lower risk of estrogen-receptor-positive breast cancer associated with migraine appears to be limited to women with early onset or long duration of migraine history and those who have migraine with aura. In a population-based case-control study, women with a more than 30-year history of migraines had a 60% lower risk of ER+ ductal breast cancer than women without a migraine history; those who had their first migraine before age 20 years had 50% lower risks of ER+ ductal and ER+ lobular breast cancer, and women who experienced migraine with aura had 30% and 40% lower risks of ER+ ductal and ER+ lobular breast cancer, respectively.