Stigma, coverage barriers preventing proper treatment of migraine

With about one in eight individuals struggling with migraine, there’s a significant overlap between migraine and mental health, according to Dr. Rob Tanguay, psychiatrist and president of the Pain Society of Alberta, during Benefits Canada‘s 2021 Mental Health Summit.

People living with migraine have a two- to four-times increased risk of having a depressive disorder compared to those without, he said, and about three out every four patients with chronic migraine report having more than two psychiatric comorbidities, such as anxiety, depression or suicidal ideation.

Patients with chronic migraine and comorbid mental-health disorders have higher health-care utilization and costs and lower quality of life, said Dr. Tanguay, noting the burden of illness of untreated migraine also leads to poor labour force outcomes. There are lower employment rates in patients with chronic migraine and “when we add in psychiatric co-morbidities, it is further detrimental to any sort of employment outcomes” he added.

Read: 2021 Mental Health Summit: Rapid access, recovery and return to work with intensive outpatient programming

There’s a bi-directional flow between migraine and mental health, according to Dr. Tanguay. Headaches can worsen or people have more headache days when mental-health conditions remain untreated or deteriorate. In addition, mental-health conditions can become exacerbated due to untreated headaches. “Hence, the need for an aggressive strategy to treat both with coordinated care in an interdisciplinary model, with the neurologist and psychologist working together.

“We need to treat psychiatric and headache disorders aggressively to improve return to work and reduce the economic burden,” he added. Unfortunately, the vast majority of patients don’t reach out for help and get appropriate treatment. “If one can get their migraine in check, then their mental health will follow.”

There are many treatments for migraine, but some patients still suffer. Dr. Tanguay said this is because some individuals haven’t responded to more traditional migraine drugs. Biological medications are available for migraines, with higher response rates and much better outcomes, both of which can have a significant impact on improving the number of headache-free days or allow some people to become headache free.

Read: Stigma, coverage barriers preventing proper treatment of migraine

“We really get to see some people’s lives change, who before the biologics had been really struggling,” he said. “That is powerful, because not only is that going to improve their mental health, but it’s also going to have an impact on their ability to get back to work.”

Migraine isn’t a mental-health disorder. However, due to the common comorbidities between migraine and mental-health conditions, employers should make sure employees are well supported psychologically and have access to medications they need to treat their migraine.

Read more coverage of the 2021 Mental Health Summit.