The comorbidity link between migraine and mental health

A migraine sufferer herself, Dr. Rose Giammarco, founder and director of Hamilton Headache Clinic, told the audience at Benefits Canada‘s 2019 Mental Health Summit that migraine can be very disabling and cause tremendous burden of disease.

“Clinically, these patients come in with severe headaches, throbbing pain that can last hours or days, sometimes weeks at a time,” she said at the event on Nov. 29 in Toronto. “Sometimes, they have this overwhelming fatigue that occurs for a day or two before the migraine begins, and then when it hits, that’s the end of it.

Read: How employers can better support workers suffering from migraines

“They have nausea, vomiting. They’re sensitive to light. They go into a dark room. They put their head under a pillow. . . . They often need to lie down, remove themselves from the environment. And then after the migraine, they still have a hangover for maybe a day or two. So although the actual attack lasted four hours . . . . you could be looking at four or five days for a complete migraine attack to be over.”

Migraines affect one in seven people, almost three million people in Canada alone, said Dr. Giammarco, and most sufferers are women. Forty-two per cent of patients who seek a diagnosis are only given a prescription, but a year later, 80 per cent of this group will have stopped taking it. “So we have a lot of things we have to deal with, with migraine patients, and optimizing their care as physicians, as well as employers and as support workers.”

Surveys of Canadian patients who suffer from migraine show 36 per cent had missed at least one day of work in the previous three months, while up to 18 per cent said it changed their work activities, she noted. “And there’s anxiety that happens in these patients that is quite disabling as well. It affects their social function, their economic status. It affects their interpersonal relationships to a tremendous degree.”

Migraine sufferers are also more prone to developing comorbidity disorders, with depression, anxiety and panic attacks higher among these patients, said Dr. Giammarco. “If I’m treating their migraine, I need to deal with the other comorbidities, because if I don’t send them for treatment for depression, if I don’t deal with things like sleep apnea or anxiety, my migraine medications aren’t going to work on them.”

Read: Migraines an underestimated, disabling and treatable condition, says medical expert

Therefore, patients with migraine and depression have worse outcomes if they aren’t treated for the depression, panic disorder or psychiatric anxiety, she noted. “In these patients, they’re definitely more likely to have more mistakes when working. So there’s a group of these patients that become disabled. Some of them go on disability.”

Migraine is a tremendous disability in Canada and all over the world. And it’s accompanied by a lot of burden in terms of interpersonal relationships, said Dr. Giammarco. “It’s the actual patient, the employer and society, whether it’s economical or emotional burden. It carries a tremendous burden of disease. The cost is quite substantial for the individual and for society.”

Improving access to care is essential, she added, whether it’s more physicians seeing patients with migraine or patient education — anyone in that circle needs to have a higher awareness of what migraine is and how to treat it.

Read more coverage from the 2019 Mental Health Summit.