Meeting migraine’s mental health challenge

According to the WHO, 1.7–4% of the world’s adult population suffers from headache on fifteen or more days every month.²  In the Lancet’s Global Burden of Disease study, migraine in 2016 was responsible for over 45 million years lived with disability.³ 

But every global statistic is made up of millions of individual stories. World Mental Health Day 2022  provides the opportunity for two patients to give their own accounts.

“My name is Ditte. I am 32 years old and I’ve had chronic epileptic migraine with aura since I was 9. I’ve often been met with “It’s just a bit of a headache – pull yourself together”. But migraine is an illness, and it’s an intense illness to live with. The big attacks - where I have to take medicine and go to bed – those I get 10-15 days a month.”

I’ve lost a lot of friends. I’ve lost a lot of boyfriends. Because when you have a relationship with me, the migraine determines if I can be there or not. I’ve had suicidal thoughts because I thought ‘This is too hard to live with. I don’t want this.’ ” 

Ditte mentions that she contemplated suicide. As a sufferer from severe, chronic migraine she is not unusual in this. In a recent prospective study with two-year follow-up, people with migraine had a greater than 4.4-fold increased risk of a suicide attempt when compared with control subjects with no history of severe headache.⁴ Increased risk appeared related to pain severity.

Ditte emphasizes how the understanding and support of family and loved ones are important in making life with migraine more bearable. Isabella, aged 24, who has had migraine for 16 years, echoes Ditte’s thoughts on the vital role played by supportive relationships. She also describes how the condition disrupts social functioning and stands in the way of educational attainment and the prospects of employment.

“Migraine is stigmatized in society. I think people have a hard time relating to migraine since it’s an invisible illness. Sometimes it can be a bit hurtful that people don’t know what it is, when you’re so disabled by it.”

“When my boyfriend and I moved in together, it was sadly one of my worst periods regarding migraine. It has been hard. It has been a real challenge for us. He has been really understanding during this process. I’m really grateful for that, because many people wouldn’t be so understanding.”

“I used to meet a lot of people. I love planning, being in control, having a fully booked calendar. But I’ve learned that I can’t do all this. It’s just harder to keep up, pass the exams – and harder to get through my education. You need to be driven – to accomplish something having migraine. It’s an illness that turns your life upside down.

The future looks bright for Isabella. I don’t know if it looks bright for migraine-Isabella. I just hope that I can handle having a job, and some day I hope I can start a family.”

Ditte and Isabella’s heartfelt accounts show how important it is at a personal level that migraine should be treated in the most effective way possible. At present, this is frequently not the case. People suffering from chronic migraine require (but often do not receive) preventive therapy as well as management of acute headache episodes.^5,6 And there is also concern that migraine is substantially under-diagnosed.⁶ The WHO has estimated that worldwide only 40% of those with migraine or tension-type headache receive a professional diagnosis.²

A recent systematic review of studies that investigated psychiatric comorbidity in migraine found that depression was almost twice as frequent among migraine sufferers as in the general population.⁷ Patients with migraine are 1-9 times more likely to have a diagnosis of panic disorder than people without migraine, and they are also more likely to suffer from generalized anxiety disorder.⁷

Recognizing the comorbidity of migraine and psychiatric ill health has profound clinical implications, the authors of the review conclude.⁷ A multidisciplinary approach to  the optimum management of both conditions might bring synergistic benefit.