PTSD Common in Migraine Patients

News Author: Megan Rauscher
CME Author: Charles Vega, MD, FAAFP
Disclosures
Release Date: April 3, 2009;

Authors and Disclosures

Megan Rauscher
Disclosure: Megan Rauscher has disclosed no relevant financial relationships.

Charles Vega, MD, FAAFP
Disclosure: Charles Vega, MD, FAAFP, has disclosed no relevant financial relationships

Brande Nicole Martin
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.


April 3, 2009 — Patients with migraine, whether episodic or chronic, are more apt to have post-traumatic stress disorder (PTSD) than the general population, suggests new research reported in the April issue of Headache. Furthermore, the presence of PTSD in migraineurs is independently associated with greater headache-related disability.

"Taken together, our findings suggest that identification and treatment of PTSD in migraine sufferers is an important and potentially modifiable part of their care that may reduce migraine-related disability and progression to chronic daily headache," Dr. B. Lee Peterlin and colleagues conclude.

In their study of 593 headache patients (mean age 42.2 years; 92% women) with episodic migraine or chronic daily headache, Dr. Peterlin's team found that PTSD was present in 30.3% of those with chronic daily headache and 22.4% of those with episodic migraine. By comparison, approximately 8% of the population is estimated to have PTSD.

"Physical or sexual abuse was reported by 42.2% of all migraineurs in the present study," Dr. Peterlin, director of the Drexel University College of Medicine Headache Clinic in Philadelphia, noted in an email to Reuters Health.

In addition, a total of 64.9% of migraineurs with PTSD reported physical or sexual abuse.

In women, Dr. Peterlin pointed out, the lifetime prevalence of PTSD is twice that of men. "Despite the clinical perception that military combat is the most common etiology, the most common causes of PTSD are interpersonal traumas, including sexual abuse," the researcher said.

"The implications are such that abuse causes not just psychological distress from PTSD but also physical pain such as migraine, and there is an increased disability seen in those migraineurs with PTSD than those without PTSD," Dr. Peterlin added.

The results also show that, in migraineurs with depression, PTSD is more common in those with chronic daily headache than in those with episodic migraine, suggesting, the researchers say, that "PTSD is a risk factor for migraine chronification in those migraineurs with depression."

Dr. Peterlin suggests clinicians "consider screening migraineurs for a history of abuse and chronic daily headache sufferers with depression for PTSD. Cognitive behavioral therapy should be considered for any migraineur with PTSD."

The author of a commentary published with the study, suggests future studies evaluate how a PTSD diagnosis modifies headache treatment.

"Pharmacologically," notes Dr. James L. Griffith of George Washington University, Washington, D.C., "dual action antidepressants, have efficacy for both migraine and PTSD, but the serotonin-reuptake inhibitor antidepressants regarded as first-line treatments for PTSD have performed poorly for migraine prophylaxis."

Headache. 2009;49:541-554.

Reuters Health Information 2009. Clinical Context

PTSD is a common and debilitating psychiatric disorder. The authors of the current review, along with an accompanying editorial by Dr. James Griffith, review the epidemiology of PTSD. Although the overall prevalence of PTSD is approximately 8%, the rate of PTSD among soldiers returning from Iraq may be as high as 18%. PTSD is twice as common among women compared with men, and approximately half of patients with PTSD have a concomitant depressive, anxiety, or substance use disorder.

PTSD has also been associated with higher degrees of chronic pain. This study examines the prevalence of PTSD among a cohort of patients seen in specialty headache clinics.
Study Highlights

* Study participants were between the ages of 18 and 65 years and were seen in one of 6 specialty headache clinics in the United States.
* All participants completed a baseline questionnaire regarding demographic data, inventories for PTSD and depression, and the type and severity of headache. Study subjects also reported on their personal history of traumatic events.
* The main study outcome was the prevalence of PTSD among patients who met standard diagnostic criteria for episodic migraine headache and chronic daily headache. Researchers also examined the severity of headache among patients with and without PTSD.
* 767 participants completed baseline questionnaires, and 593 fulfilled criteria for either episodic migraine headache or chronic daily headache. The mean age of participants was 42.2 years, and 92% were women. 87% of the participants were Caucasian.
* 10.3% of participants met criteria for major depression, with depression being more common among subjects with chronic daily headache vs migraine.
* 81.5% of participants reported at least 1 traumatic life event. The most common of these events were sudden violent death, natural disaster, and transportation crashes.
* Histories of physical and sexual abuse were reported by 27.7% and 28.8% of participants, respectively, when reported individually. 42.2% of all participants reported physical or sexual abuse when assessed together.
* The prevalence of PTSD was 25% in the patient cohort, which is much higher than the general prevalence of PTSD.
* After full adjustment, PTSD was prevalent to similar degrees among patients with migraine and chronic daily headache. The symptoms of PTSD were also similar regardless of the type of headache.
* 24.6% of participants with both major depression and PTSD had chronic daily headache compared with only 15.8% of subjects with migraine. This difference was statistically significant.
* Headache-related disability was more pronounced overall among subjects with PTSD compared with those without PTSD. This was particularly true among patients with migraine.

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* The overall prevalence of PTSD is approximately 8%, although it may be much higher in at-risk populations. PTSD is twice as common among women compared with men, and approximately half of patients with PTSD have another concomitant mood or substance use disorder.
* The current study demonstrates that PTSD is much more common among patients with significant headache compared with the general population. PTSD is also associated with higher levels of disability among migraneurs.