Clinicians have a limited repertoire when it comes to a dual approach to migraine and psychiatric treatment. Read more about Dr Moawad's presentation at the Annual Psychiatric Times® World CME Conference™.
Alleviating migraines can attenuate the presence of psychiatric comorbidities, said Heidi Moawad, MD, at the Annual Psychiatric Times World CME Conference - October 15-17, 2020. In a presentation titled “The Interplay of Migraines and Psychiatric Disorders: Treatment Implications,” Dr Moawad, clinical assistant professor, Division of Medical Education, Case Western Reserve University School of Medicine, Cleveland, OH, spoke about therapeutic interventions and best practices for migraine treatment as it relates to comorbid conditions.
Clinicians have a limited repertoire when it comes to a dual approach to migraine and psychiatric treatment. “Off label antidepressants can be used for migraine prophylaxis, and there has to be some consideration of the appropriate doses for migraine versus the dose for depression,” she said.
If patients come to a psychiatrist with a previously prescribed medication that is no longer appropriate and a change in that dose is warranted, communication and patient education are key. “Speak to the patient why that dose has been changed and what they can expect in anticipating the change.”
“Whether antidepressants are being used to prevent migraine or to treat depression, adverse effects can be very upsetting to patients and can affect their well-being,” Moawad told attendees. Patients can experience sleep disturbances, fatigue, and daytime drowsiness, and weight gain or weight loss is one of most common adverse effects that patients struggle with. Some patients can also be at risk for suicidal ideation when taking antidepressants, and some patients may experience mania as well.
In thinking about the treatment implications of migraine and psychiatric comorbidities, prescription medications are important, as are therapeutic interventions and procedures. Patients with migraine are often compliant with lifestyle modification strategies.
According to Moawad, patients are often drawn to other interventions, such as migraine prevention devices, particularly because there may be fewer adverse effects and drug interactions. Lifestyle changes, such as dietary factors (eg, avoiding certain foods), and avoiding certain odors or bright lights can be effective. Further, the use of questionnaires and other tools to monitor changes in symptoms can be useful for their own self-awareness and their own ability to assess their progress.