Migraines Can Mean More Than Just Headaches Sufferers May Be More Prone to Asthma, Back Pain, Depression

BACK

By Jeanie Davis
WebMD Medical News

Reviewed by Dr. Jacqueline Brooks

For those who push through the day despite migraines, it's not news that these sometimes-severe headaches can seriously affect a person's quality of life, day-to-day functioning, and state of mind.

Now, two new studies in the journal Neurology map out -- for the first time -- the full toll that migraine can take on a sufferer's life. The researchers say that other chronic conditions -- such as asthma, back pain, and depression -- often also plague migraine sufferers and should be treated as well. The studies point up the need for doctors to ask more questions, to talk to patients about life-affecting issues beyond the headache. With improved medications that have become available in the last few years, migraine is more treatable than ever before, the researchers emphasize.

The first study found that migraine sufferers had "significantly diminished functioning and well-being, compared with those who didn't suffer migraines," author Lenore J. Launer, PhD, chief of neuroepidemiology at the National Institutes of Aging, tells WebMD. And the more migraine attacks a person had, the worse his or her quality of life. Launer's study, conducted in the U.S. and the Netherlands, focused on 620men and women suffering from migraines. The researchers surveyed these patients by telephone to assess their quality of life during a migraine, asking about their physical functioning (such as going to work, cooking, shopping), social functioning, emotional well-being, general mood, pain, energy level, and overall health.

To put the data into perspective, Launer compared the migraine sufferers' quality of life with that of people suffering from asthma and chronicmusculoskeletal pain. These conditions share some characteristics with migraine -- the episodic attacks of asthma, and the debilitating nature of chronic back pain.

Launer found that people with migraines were significantly more likely to also have asthma and chronic back pain -- which created a worse quality of life than migraines alone. People with migraines "may need other services or programs to help them get through the day," Launer tells WebMD. Doctors should be asking their migraine patients about other aspects of their lives, she adds: "They need to treat more than just the headache; they should investigate how people's daily lives are going. For many people, having a migraine means they have to simply stop functioning in their daily activities. "Launer also uncovered another common problem. A full 54% of subjects in her study did not have a diagnosis of migraine from a physician, she tells WebMD. "Many people are still not seeking treatment when there's a whole set of new drugs available," she says.

Another study finds a "highly significant link" between depression and migraine, says author Richard B. Lipton, MD, professor of neurology and epidemiology at Albert Einstein College of Medicine in the Bronx, N.Y. In a survey of 468 people in the U.S. and 261 in the U.K., Lipton found that those with migraines had significantly lower quality-of-life scores than people without migraines. Not surprisingly, "we also found that as headache-related disability got worse, quality of life got worse," Lipton tells WebMD.

Researchers also found a "link that confirms what we've known -- that depression and migraine often coexist," Lipton says. In his study, 47% of migraine sufferers had depression, compared to 17% of people without migraines. But depression does not always accompany migraine, Lipton tells WebMD. "The two disorders are clearly separable disorders; most people who have one don't always have the other."

Which condition controls quality of life? Lipton says he had thought depression might be the determining factor, but that's not necessarily so." Migraine and depression independently affect quality of life," he tells WebMD. "If you have migraine and not depression, you still have reduced quality of life." Too often, says Lipton, physicians consider depression a byproduct of migraine -- "Of course you're depressed. You get migraines every week." And some doctors treating depression may consider a patient's headache complaint to be a manifestation of the depression. "Quite likely they are separate problems that require treatment," Lipton tells WebMD. "Some medicines that prevent migraine also prevent
depression."

Calling the two studies "large and well-designed," Werner J. Becker, MD, writes in an accompanying editorial that they "advance our knowledge of migraine." It's also clear, adds Becker, "that many patients with migraine never see a physician for their headaches, and many who do are never referred to specialists." In fact, earlier this year the U.S. Headache Consortium released comprehensive guidelines to help doctors aggressively diagnose and treat migraines. Stephen Silberstein, MD, director of the Headache Center at Thomas Jefferson University Hospital in Philadelphia, headed that effort." Migraine is starting to get more respect, but it still is not recognized [by all physicians] and lot of people are still not seeking treatment," Silberstein tells WebMD. Doctors know that migraine often accompanies other conditions, such as depression, stroke and epilepsy, says Silberstein. "What [the Launer study] suggests is that migraine is more commonly associated with asthma and chronic musculoskeletal pain," he says. "What this tells you is that the inflammatory process in the lining of the brain may be similar in migraine and asthma; that may be a common mechanism for both. As for the prevalence of back pain, it could be that the pain-control system may be defective in those with migraines and [in] back-pain patients." Further, he tells WebMD, "Patients who have asthma, chronic back pain, or depression might be having so many problems they may be ignoring their headache."

Lipton's study was sponsored by Pfizer, a company that makes both antidepressant and antimigraine drugs.