Management in Health, Vol 19, No 1 (2015)

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Aspects Concerning the Management of the Migraine Syndrome

Monica Cluadia BOER Claudia BOER, Maria Lidia NICA-UDANGIU, Lavinia TILEA

Abstract


The relationship between migraine and mental disorders represents not only a clinical reality but also an always actual research theme. There are numerous studies that attest to the high prevalence of psychiatric comorbidities in patients with migraine. Thereby among the patients presenting with chronic headaches, there is a 2 to 5 times greater likelihood of developing a mental disorder.

Among the axis I diagnosed psychiatric disorders, the anxiety spectrum (panic disorder, generalized anxiety disorder, phobias, post-traumatic stress disorder) along with the major depressive disorder and bipolar disorder are in a bidirectional relationship with the migraine syndrome.

The high rate of coexistence and the bidirectional relationship between migraine and the psychiatric disorders suggests common etiological mechanisms such as a serotonergic dysfunction, a dysfunction in the hypothalamic-pituitary-adrenal axis and fluctuations in the serum concentrations of the ovarian hormones. Also, recent studies in genetics are showing a common genetic model that could explain these comorbidities.

The psychiatric comorbidities are clinically relevant because of the negative impact on the patient’s quality of life and the increased difficulty of the therapeutic process (a long evolution, an insufficient therapeutic response and an increased risk of polipharmacy).

Pharmacotherapy represents a challenge. In the clinical practice monotherapy does not constitute an effective therapeutic conduct. Thus, among all classes of antidepressants, only the tricyclic antidepressant amitriptyline is effective both as an antidepressant and anxiolytic as well as a treatment of migraine. However, in some cases side effects limit its use. The pharmacotherapeutic attitude requires a separate approach for migraine and comorbidity, taking into account the proper dosages and the potential drug interactions.

Conclusions: Given the high prevalence, the negative impact on the quality of life and the therapeutic challenges, further studies are needed to provide a better understanding of the pathological mechanisms, clinical implications and consequently to develop better therapeutic algorithms for this combination of disorders.

 

Keywords: Case management, Migraine syndrome, antidepressanst, anxiolytics


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