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Are migraines [anxiety disorders] and bipolar disorder related?

« H E » email
posted Monday, 17 April 2006

Are Migraines and Bipolar Disorder Related?

....The most noteworthy findings concerning the clinical characteristics were that patients with migraine had a higher frequency of affective temperaments (47% versus 22% in patients without migraine) and a higher number of anxiety disorders. They were more likely to have panic disorder (51% versus 24%) and agoraphobia (58% versus 27%) than the patients without migraine. Symptoms during depressive episodes were similar, except that the migraine patients reported irritability and suspiciousness with increased frequency.

In two epidemiological studies, one from Zurich, Switzerland, (Merikangas et al., 1990) and one from Detroit (Breslau and Davis, 1992), a clear relationship between migraine and major affective disorders has been found (Breslau et al., 1994). In the Zurich study, people with migraine had a threefold-increased one-year prevalence of bipolar spectrum disorders (9% versus 3%), a nonsignificant increase in manic episodes and a twofold-increased prevalence of major depression (15% versus 7%).

Although these results cannot be directly compared to ours, they show that the association of migraine and affective disorders is not only found in such a selected group as we have studied. In these epidemiological studies, people with migraine also had an increased frequency of anxiety disorders. In the study by Breslau and Davis (1992), the frequency was doubled, compared to people without migraine, and the association was especially strong for panic disorder, with a sixfold increase. In contrast to these findings in patients with affective disorders, a study of patients with schizophrenia found no increased frequency of migraine (Kuritzky et al., 1999).

In our second study, the age of onset of the first anxiety disorder (most often a specific phobia) for patients with migraine was 15 years of age. This was earlier than the onset of migraine (21 years), which again was earlier than the onset of the first depressive episode (26 years). The first hypomanic episode occurred at age 28 (Figure). These chronological relationships are in agreement with previous studies. The high prevalence of anxiety disorders in patients with major affective disorders and comorbid migraine supports the hypothesis that there is a syndromal relationship between migraine, anxiety and depression (Merikangas et al., 1990). We would add that bipolar features should be included as part of this syndrome, and possibly the presence of migraine may be used to delineate a distinct subgroup of the major affective disorders.


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tags: panic disorder  manic depression  specific phobia    migraine  bipolar disorder  

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