Which came First? Chicken or Egg?
Unfortunately, there doesn’t seem to be consensus on this question!
Migraine appears to have several comorbidities. Different questions arise about whether or not these medical conditions are linked to migraine. Some of these questions are;
- Does one disorder cause the other? If so, is migraine causing fibromyalgia or vice versa?
- Are they triggers of each other rather than causes? e.g. the pain and fatigue of fibro may not be a root cause but may trigger a migraine attack
- Is there an underlying element that causes both e.g. Genetics – they run in the family?
- Is it just coincidence?
- Is it my imagination? Am I going crazy?
Medically you will probably find several opinions to fit all of the above, but whatever way you look at it, if you suffer from migraine, the last thing you need on top of that is another medical issue.
What is ‘Comorbidity?’
Comorbidity is defined as “A medical condition existing simultaneously but independently with another condition in a patient, or a medical condition in a patient that causes, is caused by or is otherwise related to another condition in the same patient.” Dr. Edmund Messina, MD FAHS, Michigan Headache Clinic.
Confused? Simply put, comorbidities are two conditions that occur together and can be related or unrelated. Dr. Kenneth Thorpe’s 2017 paper “Prevalence, Health Care Spending and Comorbidities Associated with Chronic Migraine Patients.” states that 90% of people with chronic migraine will have at least 1 additional chronic condition.
Types of Comorbidities Associated with Migraine
Comorbidities that can occur with migraine include;
- Fibromyalgia – See also this booklet from Arthritis Ireland — https://bit.ly/2GfoJML
- Chronic Fatigue (CFS) – http://www.cfsselfhelp.org/
- Post-Traumatic Stress Disorder (PTSD)
- Panic Disorders
- Irritable Bowel Syndrome
- Sleep Disorders
- Raynaud’s Syndrome
- Suicidal Ideation
Mental health issues such as depression and anxiety have been highlighted in previous research on migraine as comorbidities. As a migraineur, you have a painful, debilitating neurological disorder that has the potential to take over and control your life. On a continuous basis this would get Superman down!
One things feeds into another, then another and another and another, then before you know it, you’re living alone, in your own (dark) Fortress of Solitude away from family, friends and anyone who can look at you strangely and say ‘Seriously, headache? Sure everyone gets them. Do you not have a Panadol?!” (wishing you had the ability to shoot laser beams from your eyes does not help!)
This is bad enough when coping with migraine on its own, but add in additional agony from Fibro, the extreme exhaustion and inability to physically raise yourself up from CFS, the cold, dead-looking fingers of Raynaud’s syndrome and you would be praying for Krypton to explode while you’re on it.
Treating the Comorbidities of Migraine
Treating comorbidities of migraine can be complicated as it largely depends on the type of comorbidity; e.g. some people with heart problems may not be able to take migraine specific medications such as Triptans which close the blood vessels. Where as someone with anxiety or depression might see improvements in both their migraine and their mental health with something like an anti-depressant or non-medical cognitive behavioural therapy (CBT), mindfulness, etc.
Medical Opinion is divided about Chicken or Egg but…
Some of the meds already in use for migraine may already have an effect on some of the comorbidities; e.g. amitriptyline is an anti-depressant and can help steady the activities of neurotransmitters in the brain. It’s used for both migraine and fibromyalgia, but was developed to treat depression and anxiety, so killing a whole lot of chickens with one giant egg there… (with apologies to vegans and PETA)
Unfortunately amitriptyline, like all meds, doesn’t work on everyone and some people can’t tolerate the side-effects so other options need to be explored.
The best plan of action:
- Diagnosis: Get an accurate diagnosis for the type of migraine you have and any coexisting condition.
- Treatment: Get a clear treatment plan and stick to it. Remember to give medication, and indeed any supplements such as Magnesium, a decent chance to act. Some take about 3 months to kick in, so taking them for a week and then not taking them again won’t help prove their effectiveness (or lack of it) at all and will frustrate you and your medical specialist.
- Lifestyle factors: These are an important part of managing any medical condition. People with migraine can benefit from monitoring and changing some lifestyle issues. Here are some of the most common lifestyle factors that need monitoring:
- Sleep – A good sleep routine and the right amount of sleep is very important
- Food – Making sure you eat and drink enough, and not allowing yourself to go hungry. Fasting and dehydration may make migraine or other conditions worse, and can certainly trigger attacks. Look after your Second Brain.
- Exercise – This can be a double-edged sword as migraine is typically made worse by movement, but the general benefit of exercise is huge, and for many of the conditions mentioned above, low impact exercise like walking, cycling, swimming can make a huge difference.
- Fresh Air – The benefit of spending time outdoors is immeasurable. It might be worth looking up what’s called ‘The Blue/Green Gym‘ – Sea swimming, forest-bathing, walking in your local park or even around your estate, can all help with migraine and also have a very positive effect on your mental as well as physical health.
- Limit the amount of alcohol, caffeine and OTC medications. Speak to your neurologist, GP or pharmacist before trying or changing medications
USE A DIARY – whatever your disorder is…
I can’t stress this enough! It’s possibly one of the most important and effective things you can do for your medical issue. Noting symptoms, occurrences, the successes or failures of treatment, etc. may help your doctor/s to figure out how best to help you. They may see patterns emerging, medications that need to be adjusted or changed, times when you might be more susceptible to attacks, etc.
Sometimes, it’s not Chicken or Egg, it’s Chicken and Egg!
Having comorbidities is not at all unusual; you’re not going mad, you’re not imagining things and you’re not alone. If you want further information on migraine please email us at email@example.com and look at the websites of some of the excellent organisations who offer support and information for the conditions mentioned above. One of the best is Chronic Pain Ireland They cover a multitude of chronic pain conditions. See also this page on the HSE website that contains information and videos that might help with many of the above conditions