The World Health Organisation (WHO) counts migraine as one of the most severely disabling illnesses affecting humanity; in general, headache disorders are a great burden to those affected by them. In addition, people suffering from headaches or migraine have a higher risk of developing further illnesses or problems alongside their headache disorder. Emerging research is focusing increasingly on so-called comorbidity with headache and migraine. This article presents the newest findings in this field.

Extensive studies show an increased risk for people with headaches

An extensive review from 2021 analysed data from 139 studies from the years 2000 to 2020, which involved over 4.2 million people with headaches: accompanying illnesses with headache and migraine were reported in 2.7 million cases. The most commonly named comorbidities were depressive disorders, high blood pressure, and anxiety disorders. After the intensive research of the past decades it can be regarded as certain that primary headache disorders are connected or associated with a variety of comorbidities. This means that people suffering from a primary headache disorder are fundamentally at a higher risk of certain accompanying illnesses. Primary headache disorders are independent disorders, which distinguishes them from secondary headaches. The latter frequently occur as a consequence of other illnesses or injuries, for example, as a side effect of concussion or advanced sinusitis. By far the most common primary headache disorders are migraine and tension-type headache.

Correct diagnosis of comorbidities: indispensable and yet very rare

The examined studies show that accompanying illnesses for headaches are often not diagnosed correctly and are attributed to the underlying headache. For example, symptoms of anxiety or depressive disorders are often not recognised as such, which in turn makes targeted treatment impossible. The analysis shows that treating doctors often have too little awareness or knowledge of accompanying illnesses for headaches and that patients are not getting the support for their symptoms that would help them. This can have serious consequences for affected people, because a holistic diagnosis which takes all relevant factors into consideration can lessen their suffering and significantly increase their quality of life.

The accompanying illnesses are varied

People affected by primary headache disorders were found to have around 20% higher prevalences of depression and anxiety than the headache-free population. Younger rather than older and female rather than male patients are particularly severely affected. The most commonly occurring psychiatric comorbidities were anxiety (25%), depression (23%), and post-traumatic stress disorder (15%) – migraine patients are particularly affected here. In addition, physical illnesses such as high blood pressure also occur at a higher rate, although older age groups and male patients are more severely affected by these. Heart and circulation disorders form a significant part of the accompanying illnesses for headaches. Thus, migraine (especially migraine with aura) in young women puts them at significant risk of a stroke. Ischemic heart diseases also occur more frequently in migraine patients than in the average population.

The negative impacts on affected people increase with psychiatric comorbidities

A newer study from 2020 considers the degree of personal impairment which affected people experience through their migraine in relation to the additional impairment from accompanying psychiatric illnesses. For this, they used the so-called MIDAS grading, a parameter established in medical practice which shows the individual levels of impairment for people with headaches. The proportion of patients with a MIDAS grade showing a moderate to severe impairment was around 28% for “migraine only” patients. If they also had anxiety, this rose to 43%, and to 51% with depression. For people with migraine with both accompanying illnesses, the proportion rose to 61%. This data shows a measurable, significant increase in the suffering of migraine patients who experience psychiatric illnesses in addition to their primary headache disorder.

A vicious cycle of headache and comorbidity

We must pay particular attention to the fact that primary headache disorders and accompanying issues can influence each other. Researchers have long considered anxiety and depression states as undisputed triggers of migraine attacks. When they occur simultaneously as a result of regular headaches, it becomes clear how closely headaches and accompanying illnesses are interlinked. The same problem is apparent with sleeping disorders. Sleeping disorders very frequently occur in parallel with headache disorders; relevant studies state that the average prevalence is 48%. On the one hand, sleeping disorders can function as a trigger for headaches, on the other hand, studies describe that frequent headaches are a significant disruptive factor for restful sleep. This, in turn, has a strong influence on mental wellbeing, as sleeping problems can, among other things, lead to accompanying depressive illnesses long-term.

Sustainable prevention can be effective in many ways

The above statement is supported by the longstanding maxim that good sleep hygiene must be a central pillar in the prevention of headaches and migraine, and also shows its relevance for their accompanying illnesses. Generally, we can see from the aforementioned studies that the sustainable prevention of migraine and headaches does not simply prevent the primary illnesses themselves, but can also indirectly prevent a variety of potential accompanying symptoms. The lighter the burden of headaches, the lower the risk of potential comorbidities and their mutual causation. At the same time, the medical care of the affected people needs to be rethought, so that strenuous accompanying symptoms can be reliably recognised and treated in a targeted manner, and so that particularly those who are worst affected are not left alone with their many ailments.