Daily Migraine Attack May Follow Psychiatric Disorders

Daily Migraine Attack May Follow Psychiatric Disorders

Migraine is now recognized as a chronic illness, not simply as a headache. Migraines are defined by whether auras accompany them or not:


Before a migraine starts, there is often a warning period when you don't feel well. Some people lose part of their vision or see bright spots or zigzag patterns in front of their eyes. These symptoms, which may precede and predict a migraine headache, are called migraine aura. The vision changes of the aura usually go away as the headache begins. Many people with migraines do not have the visual symptoms.

A person may experience one or the other at different times.People with migraines often feel dizzy or sick to their stomachs. They may be sensitive to light, noise, or smells. In a few people, migraines can also cause auras, such as seeing spots or halos, just before actually getting the headache. Migraines can be disabling, and teens with migraines often need to skip school, sports, work, or other activities until they feel better.

Migraines are very common: 6 percent of men and 18 percent of women suffer from these disabling headaches at some point in their lives - most commonly between the ages of 25 to 55. Of those people, 60 percent have at least one fairly severe migraine every month - often severe enough to warrant calling in sick, says U-M neurologist Linda M. Selwa, M.D. "Migraines are a significant cause of disability in this country, resulting in an estimated $13 billion dollars in lost work hours each year," she says.

If you have migraines, you are not alone. Experts estimate that up to 10% of teens and young adults in the United States get migraines. Before age 10, an equal number of boys and girls get migraines. But after age 12, during and after puberty, migraines affect girls three times more often than boys.If untreated, attacks usually last from four to 72 hours. A typical migraine attack produces the following symptoms.Throbbing pain on one side of the head. The word migraine, in fact, is derived from the Greek word hemikrania, meaning "half of the head" because the pain of migraine often occurs on one side. Pain also sometimes spreads to affect the entire head.

Migraines differ from tension headaches in that they're usually only on one side of the head. They are often severe enough to be associated with nausea and to make sufferers shy away from light and sounds. Many have visual disturbances, and often migraineurs are not able to keep up with their usual daily activities.

There are many possible triggers of tension headache. You may have no identifiable or consistent trigger, or have several obvious ones. Potential triggers include:Stress,Depression and anxiety,Lack of sleep or changes in sleep routine,Skipping meals,Poor posture etc.

Relapse is common after the withdrawal of acute-headache medications, both in patients who were no longer experiencing chronic daily headache after medication withdrawal and in those who continued to have chronic daily headache but who were initially successful in decreasing their intake of acute-headache medications. One large, prospective study indicated a relapse rate of 38 percent in the first year and a rate of 42 percent after four years.In another report, 60 percent of the patients continued to have chronic daily headache and were overusing acute-headache medications four years after the initial withdrawal of the medication.

Chronic daily headaches occur more than 15 days a month — often daily. The signs and symptoms vary depending on the specific type of chronic daily headache.Sometimes migraines gradually become more frequent, until you experience pain nearly every day. This is known as transformed migraine. You may feel steady pain on one or both sides of your head, as well as pain in your neck and face. The common migraine symptoms of nausea and sensitivity to light and sound often fade, but you may continue to experience occasional acute migraine attacks. Depression, sleep disturbances, anxiety and panic are common as well.

Throbbing migraine headaches and major depression may be related. In fact, having one may increase the occurrence of the other.

Migraine sufferers were five times more likely than headache-free individuals to develop major depression .A person with major depression was more at risk of suffering a first-time migraine than non-depressed individuals. And people who live with migraines seem to be more at risk for an initial bout of depression.Both disorders are biologically linked, possibly with brain chemicals or hormones. They suggest that treatment for one should look for the presence of the other.

Teenagers who suffer from near-daily migraines may have a higher-than-average risk of depression, anxiety and suicide, research hints.

The reasons for the connection are not fully understood, said the study's lead author, Dr. Shuu-Jiun Wang, of Taipei Veterans General Hospital in Taiwan.

But, Wang told Reuters Health, the prevailing theory is that some people have an underlying vulnerability to both migraine and certain psychiatric disorders.

The findings, which appear in the journal Neurology, are based on psychiatric interviews with 121 teenagers who suffered from various forms of chronic headache -- including chronic migraine, chronic tension headache and chronic headaches stemming from pain medication overuse.

Migraine headaches cause intense, throbbing pain, along with sensitivity to light and sound, and nausea in many cases. A minority of migraine sufferers also experience an aura -- visual disturbances or other bodily sensations that precede the migraine attack.

Chronic migraine is diagnosed when the attacks happen at least 15 days out of every month.

In their study, Wang's team found that nearly half of all the 12- to 14-year-old headache sufferers they interviewed had at least one psychiatric disorder. That rate is far higher than what's seen among Taiwanese teenagers in general, they note.

Teens with chronic migraine were particularly at risk, showing higher rates of depression and anxiety disorders -- including panic attacks and obsessive compulsive disorder -- than their peers with other forms of chronic headache.

Suicidal thoughts and behaviors were also unusually common in the study group as a whole, with 20 percent showing a high risk of suicide. But teenagers who suffered migraine with aura were especially at risk.

Of these 14 teens, half showed a high risk of suicide based on a standard questionnaire, versus 21 percent of their peers who suffered migraines without aura, and 7.5 percent of those without migraine.

There's no immediate explanation for why migraine with aura, specifically, would be linked to suicide risk, Wang said. But it's possible that dysfunction in the brain's serotonin system helps explain the link between psychiatric problems and chronic migraine in general, according to the researchers.

Serotonin is a chemical that helps nerve cells communicate, and research has implicated it in both migraine and certain psychiatric disorders, including depression and anxiety.

According to Wang, parents of children with chronic migraine should ask for a consultation with a psychiatrist if they feel their child is depressed or has other mental health problems.

But the researcher also stressed that the findings apply to chronic migraine, and it's unknown whether children with occasional migraine attacks have similarly elevated risks.

Most patients with chronic daily headache have a history of episodic migraine and overuse acute-headache medications.On the basis of clinical experience, an expert suggests "I would also encourage the patient to limit or eliminate caffeine consumption, exercise regularly, and maintain a regular sleep schedule. Moderate or severe headaches that occur after the withdrawal of overused acute-headache medication could be treated with a nonsteroidal antiinflammatory agent or intranasal or parenteral dihydroergotamine; antiemetics are helpful for headache-induced or drug-induced nausea".

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