From the Guidelines
Yes, a psychiatry clinic can effectively manage migraines, particularly when they occur alongside depression and anxiety, as the most recent and highest quality study suggests that recognizing and managing comorbidities is crucial for optimal treatment outcomes 1.
Key Considerations
- Migraine management in a psychiatric setting can be beneficial due to the overlap of brain pathways involved in migraine, depression, and anxiety, which often involve similar neurotransmitters like serotonin and norepinephrine.
- Preventive medications such as amitriptyline (10-150 mg daily) and topiramate (25-200 mg daily) can serve dual purposes by treating both depression and migraines.
- For acute migraine attacks, triptans like sumatriptan (50-100 mg as needed) may be recommended.
- SSRIs like sertraline (50-200 mg daily) or SNRIs like venlafaxine (75-225 mg daily) can be prescribed to manage depression and anxiety, which can trigger or worsen migraines.
- Cognitive behavioral therapy is frequently incorporated to help patients identify triggers and develop coping strategies.
Management Approach
- The approach should be comprehensive, addressing both the migraines and the comorbid psychiatric conditions.
- Treatment plans should be tailored to the individual, considering the specific comorbidities and the potential for drug interactions.
- Regular follow-up is necessary to evaluate treatment response and adjust the management plan as needed.
Evidence Base
- The most recent guidelines and studies, such as those published in Nature Reviews Neurology 1, support the effectiveness of a multidisciplinary approach to managing migraines with comorbidities.
- Older studies, while still relevant, may not reflect the current best practices or the latest advancements in treatment options 1.
- The importance of recognizing and managing comorbidities, such as depression and anxiety, is highlighted in the most recent research 1.
From the Research
Migraines and Psychiatry Clinics
- Migraines are a highly prevalent and disabling neurological disorder associated with a wide range of psychiatric comorbidities, including depression, anxiety, and post-traumatic stress disorder 2, 3, 4.
- The associations between migraines and psychiatric comorbidities are complex, with a bidirectional association of major depression and panic disorder with migraines 3.
- Psychiatric comorbidities may be associated with poorer treatment response for some acute pharmacotherapies, but people with comorbid migraine and mood or anxiety disorders can achieve large responses to preventive pharmacologic and behavioral therapies 5.
Managing Migraines in Psychiatry Clinics
- A comprehensive evaluation of psychiatric disorders in migraine is necessary to promote an integrated model of care and address the burden and psychosocial impairment related to psychiatric comorbidities in migraine 3.
- Optimizing the pharmacological and non-pharmacological treatment of either migraine or its psychiatric comorbidities might help clinicians to attenuate the burden of both conditions 3.
- Emerging research is developing and evaluating behavioral treatments designed to manage cooccurring migraine and mood or anxiety disorders 5.
Comorbidities and Migraine Treatment
- Anxiety and mood disorders are prevalent in people with migraine, and psychiatric comorbidity is associated with greater migraine symptoms and disability 5, 6.
- A symptom-based approach may improve our understanding of migraine comorbidity, and research has shown that anxiety is more robustly associated with an increase in migraine risk than depression 6.
- Lack of ability to properly control worrying and to relax are the most prominent issues in migraine psychiatric comorbidity, and physical symptoms in depression are more linked to migraine than emotional symptoms 6.