Migraine comorbidities
If you suffer from migraines you are at a higher risk of having certain other medical problems, or comorbidities. They are not the result of having migraines, nor do those condition cause migraines. Most likely, they may have common underlying genetic, environmental, or behavioral factors. You should be aware of this link because treatment choice may be affected by the presence of these comorbidities.
Here is the list of conditions more common in migraines: anxiety, asthma, bipolar disorder, chronic pain, depression, fibromyalgia, reflux (GERD, or heartburn), irritable bowel syndrome (IBS), high cholesterol, hypertension, obesity, sleep apnea, TMJ syndrome. Having these coexisting diseases increases the risk of worsening (chronification) of migraines.
Migraine often coexists with another one or more painful conditions listed above – chronic pain (low back and other), fibromyalgia, irritable bowel syndrome, and TMJ. One plausible explanation is that chronic pain of one type leads to an increased sensitivity of brain cells. This increased sensitivity is well documented and is called wind-up phenomenon. Fortunately, many treatments can address several pain syndromes at once. These include antidepressant drugs (amitriptyline, duloxetine, and other), cognitive-behavioral therapy, exercise, and other.
One possible explanation for the coexistence of psychiatric disorders is that 40-60% of people with chronic pain have a history of physical, emotional, or sexual abuse and may suffer from posttraumatic stress disorder (PTSD). Another cause could be that they share serotonin and other neurochemical disturbances in the brain. Here too, antidepressants or certain epilepsy drugs may address both migraines and mood disorders.
Reflux (GERD) often seen in migraine sufferers could be the result of taking too many anti-inflammatory drugs such as ibuprofen, aspirin, and naproxen. Many patients will treat their heartburn with drugs such as omeprazole (Prilosec), which after prolonged use can cause multiple vitamin deficiencies, which in turn can worsen migraines and cause other symptoms.
Migraine has an inflammatory component and obesity is known to be pro-inflammatory, which could explain this connection. Diabetes drug, metformin could be a useful drug for patients who have difficulty losing weight with diet and exercise alone.
I cannot provide specific advice to patients I haven’t seen, but I do have some patients who have been taking 300 or 400 mg of magnesium twice a day with good relief and without getting diarrhea. This amount of magnesium can be dangerous for people with serious kidney problems.
Hello Dr Mauskop, I have been taking 300 mg of Magnesium Glycinate for last one year and it has helped me control chronic migraines. However, last two months I have been having migraines that stay for more than a week. I wanted to know if it is ok to increase the dose of Magnesium to 600
(or more) for a few days until the migraine goes away?
Unfortunately, very little magnesium gets absorbed through the skin, so deodorants or magnesium skin sprays are not very effective. Even oral magnesium is poorly absorbed in 10-20% of people.
Thank you Dr Mauskop. That’s good to know. I have noticed recently some stores are now selling magnesium deodorants. Do you think that could be a good way for migraneurs to increase our magnesium intake, in case we don’t absorbe supplements as well?
Migraines tend to begin at a young age when blood pressure tends to be low in most people. And yes, many young women have low blood pressure. However, high blood pressure can develop in the 40s and 50s at a higher rate than in the general population, even if pressure was low in the teens and 20s. As far as feeling cold, many migraine sufferers feel cold all the time, which is often due to magnesium deficiency. Taking magnesium can often help prevent migraines and increase circulation. During an attack, many people find that getting into a hot tub or under an electric blanket and at the same time having an ice pack applied to the head helps relieve the pain.
Thank you Dr Mauskop. I am surprised to see hypertension in the list of comorbidities, I thought most migraneurs had hypotension. I myself have always had low blood pressure. I have noticed when I get I migraine, I feel very cold, I get chills sometimes and my hands and feet are always super cold. And for some reason my face feels very hot. Have you seen that a lot and do you know why?
Thank you.