Anxiety Disorders Associated with Migraine Disease

As researchers investigate the connection between migraine disease and other conditions, we're learning that there are connections between migraine and other conditions — conditions that are invisible, about which there remain many myths and misconceptions, and conditions that are even more difficult for us because those around us often don't understand them.

"...Painful conditions like migraine and arthritis could increase a patient's anxiety about the pain, or panic attacks may be mistaken for asthma attacks... Physicians are becoming more aware of the importance of recognizing and treating depression... Our study shows that anxiety is also very common and that similar efforts are warranted." ~Dr. Jitender Sareen

We've already learned that while major depressive disorder affects 17 percent of the general population, it affects 47 percent of migraineurs. We recently learned that people with bipolar disorder have a significantly higher prevalence of migraine when compared to the general population. There is also evidence of comorbidity of depressive and anxiety disorders in chronic daily headache, and its subtypes including some types of migraine.

A new article published in the Archives of Internal Medicine reports on a study that investigated the connection between anxiety disorders and physical disorders as well as the impact of that connection.

Introduction:

"The negative impact of comorbidity of depression with physical illness has been well documented, and evidence has been emerging to show that anxiety disorders are associated with several physical health problems..."

There is a growing body of evidence that anxiety disorders are often comorbid with physical disorders, but there have been limitations to previous studies because of potential sample bias and patient assessment having been performed by lay interviewers rather than mental health professionals. To avoid such limitations, Sareen et al used the German Health Survey (GHS) to study the relationship between anxiety disorders and physical disorders. The GHS was the first study to assign Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses using the Composite International Diagnostic Interview, said diagnoses assigned by physicians based on interview, physical examination, and laboratory assessment.

Study objectives:

1. To examine "whether there were unique associations between the presence of an anxiety disorder with particular physical conditions."
2. To examine "whether the comorbidity of anxiety and physical health problems was independently associated with poor quality of life and disability even after adjusting for potential confounding factors (e.g., overall burden of physical illness)."

Study methods:

The GHS assessed physical conditions based on a combination of three methods:

1. a self-report questionnaire, which asked about the presence of 44 physical conditions
2. a standardized computer-assisted medical interview by a general practice physician
3. blood pressure measurements and analysis of blood and urine samples.

Physical conditions were included only if there was previous empirical evidence of an association between anxiety disorders and the physical condition was prevalent enough to be included.

Study results:

After Sareen et al adjusted for sociodemographic factors and other common psychological disorders, an anxiety disorder was significantly associated with:

• allergies
• arthritis
• gastrointestinal disease
• migraine disease
• respiratory disease
• thyroid disease

Study conclusion:

"In conclusion, the current study demonstrated that anxiety disorders are uniquely associated with several physical health conditions in the community, and this comorbidity is itself associated with poorer functional outcomes. In combination with recent data demonstrating that anxiety disorders are risk factors for suicidal behavior, the current study suggests that anxiety disorders should be considered an important public health problem in the community. During the last decade, efforts have been substantially increased to improve recognition and treatment of depression in general practice. Similar efforts should be strongly considered for anxiety disorders."

For more information on migraine and comorbid mental health issues, see:

• Beyond the Pain of Migraine
• Bipolar Disorder and Migraine Comorbidity
• Anxiety Disorders and Headaches
  from Anxiety & Panic Disorders Guide Cathleen Henning

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Resources:

Jitender Sareen, BSc, MD, FRCPC; Frank Jacobi, PhD; Brian J. Cox, PhD; Shay-Lee Belik, BSc(Hons) ; Ian Clara, MA; Murray B. Stein, MD, MPH . "Disability and Poor Quality of Life Associated With Comorbid Anxiety Disorders and Physical Conditions." Arch Intern Med. 2006;166:2109-2116.

Gale, Karla. "Comorbid Anxiety Disorders Worsen Effects of Physical Diseases." Reuters Health Information. October 24, 2006.