Migraines Can Mean More Than Just Headaches
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 substantially 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.