Migraine and Common Morbidities



Migraine and Common Morbidities

For many patients, migraine is associated with other illnesses such as:

  • Depression
  • Anxiety
  • Stroke
  • Irritable bowel syndrome
  • Epilepsy
  • Hypertension
These illnesses are now recognized as being common migraine comorbidities. The term comorbidity is used when two illnesses occur at a greater than coincidental rate than what is seen in the general population. This suggests that at some level, the two illnesses are interrelated.
When two conditions are found in the same person but the incidence is not greater than what is seen in the general population, these are referred to as coexisting conditions. For example, a patient may have migraine and diabetes. There is no evidence suggesting that these two conditions exist in a single patient more frequently that these conditions exist in individual patients in the general population. In contrast, migraine and depression appear to be comorbid because they occur together more often than they occur in individual patients in the general population.
Understanding the association of migraine with other health conditions is an important part in providing optimal care. Once a person has been diagnosed with migraine, it is important to consider that other medical conditions may also be present. This is why a complete medical history and exam is needed in all patients receiving a work-up for migraine.
When a comorbid condition is identified along with migraine, treatment now becomes more complex because there are two separate conditions to manage, and both conditions may be interrelated. For example, if someone is struggling with a bout of difficult depression, they may find their migraine attacks become worse. If depression improves, they may find that their migraine also improves. For this reason, migraine and potential comorbid conditions need to be accurately diagnosed.
If migraine and another associated illness is considered, there are several easy steps to you can take.
  1. DIAGNOSIS: Get an accurate diagnosis for the type of headache you may have and the existing comorbid or coexisting condition.

  2. TREATMENT: Get a clear treatment plan. For some patients, a single medication may successfully manage both conditions, while others may need more than one medication.
    1. Monotherapy: For example, some patients with depression may be well controlled with an antidepressant that is also effective in reducing migraine frequency.
    2. Polytherapy: However, it is important to acknowledge that for many patients, polytherapy is the optimal approach. This means that each condition can be treated independently using separate medications with individual dosing regimens. This may take some time getting used to the routine of managing two conditions using different medications.

  3. LIFESTYLE: Often lifestyle factors are an important part of managing any medical condition, and migraine is one of these. Patients with migraine will benefit from monitoring and addressing lifestyle factors that may be making migraine or other conditions worse. Below are common lifestyle factors to consider as playing a potential role in migraine and associated cormorbidities.
    1. Maintain routine sleep and appropriate amounts of sleep
    2. Maintain routine eating and drinking habits. Prolonged periods of fasting, dehydration, or hyperglycemia (too much sugar) may all make migraine or other conditions worse.
    3. Limit caffeine, alcohol and other nonprescription medications. Use of any medication should be discussed with the health care provider.
    4. Follow treatment plans as instructed. Any need to make modifications to the treatment or dosing plan should be addressed with the physician first.
    5. See appropriate cognitive, behavioral, and psychological therapy as recommended.

Overall, many individuals find that they have multiple health conditions at the same time. It is important to realize this is NOT unusual, rather a common occurrence. Seeking an accurate diagnosis and initiating treatment is the most important step to improving your overall health.

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