Comorbidity of Migraine and Psychiatric Disorders

There is now substantial evidence to corroborate early anecdotal clinical descriptions regarding the co-occurrence of migraine and psychiatric disorders. Clinicians involved in the treatment of migraine often have described a set of characteristic features of migraineurs that include anxiety, depression, and social fears. Wolff33 in 1937 was so convinced of this constellation of attributes that he is often credited as being the initiator of the concept of the purported migraine personality. More careful inspection of his description, however, reveals that the characteristics of extreme physical fatigue, apathy, and anxious anticipation are more akin to psychiatric symptoms than personality traits. Earlier descriptions of these characteristics also can be found throughout the clinical literature. The most common features of these descriptions are depression characterized by anergia and anxiety disorders, particularly panic disorder and phobia. The contemporary equivalent to these features are the atypical subtype of depression. This article reviews the evidence for comorbidity of migraine with psychiatric disorders, particularly the affective and anxiety disorders. In addition, the methodologic issues, possible mechanisms, and implications of comorbidity are discussed. Finally, recommendations are made for future studies to address the gaps identified in this article.