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Panic Disorder and Migraine: Better Understanding the Connection

Physical and mental health disorders, including depression and anxiety, often afflict migraineurs, with current research indicating that panic disorder (PD) is the anxiety disorder most often associated with migraine.

In a review article in the January issue of the journal Headache, Todd Smitherman, PhD, FAHS, from the University of Mississippi, and colleagues explored PD, migraine and the connection between the two to better understand assessment and treatment of affected patients.

In the general population, anxiety disorders are the most common psychiatric disorder, appearing at some point in nearly 30% of the population. Among migraineurs, the odds increase, with up to 58% of the population experiencing at least one anxiety disorder during their lifetime and between 5 and 17% experiencing PD, which is marked by short periods of intense fearfulness, or panic attacks. Rates of PD are even higher for those with chronic migraine (25 to 30%) and migraine with aura. The authors note that PD is also most common among migraineurs who seek treatment and those who seek care from specialty clinics.

This connection is also evident when examining the link from the other direction. More than 60% of outpatients with PD experience migraine, the authors noted.

While the two disorders may seem quite different initially, they share many characteristics: They are both chronic disorders that manifest themselves episodically. During an attack, those affected are functionally impaired, and between episodes, there is considerable worry about when the next attack might appear. Additionally, both disorders may include similar symptoms, including gastrointestinal distress, dizziness and fear.

When a person experiences both PD and migraine, their medical costs rise significantly compared to migraineurs without a psychiatric disorder; those with both disorders report more disability and functional impairment and decreased quality of life. They are also at an increased risk of overusing medications and developing medication overuse headache.

In the clinic, the implications of the PD-migraine link illustrate that it is important for health care professionals to assess their migraine patients for panic and to rule out other medical conditions. When medications are warranted, the authors note that the disorders are currently best treated with separate pharmaceuticals. When PD is moderate to severe, patients should be referred to a mental health professional to provide panic control treatment and pharmaceutical treatment, if appropriate.

Finally, the authors call for more research so that the underlying mechanisms of both disorders are better understood and that cost-effective and integrated treatment may be developed.

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