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Migraines most commonly affect adults in their 30s and 40s, but they
frequently start at puberty and also can affect children. Women are up
to three times more likely than men to have migraines. Though statistics
specifically for ocular migraines are unavailable, approximately 15 to
18 percent of women and 6 percent of men in the United States suffer
from migraine headaches, according to WHO.
According the the World Health Organization (WHO), migraines "almost
certainly" have a genetic basis, and some studies say 70 percent of
people who suffer from the disorder have a family history of migraine
Migraine is associated with a
number of neurological and psychiatric disorders, including stroke, epilepsy,
depression, and anxiety disorders. Feinstein (1970) coined the term “co morbidity,”
which now refers to a greater than coincidental association of two conditions
in the same individual (Lipton and Silberstein, 1994). Possible explanations
for co morbidity include the following:
shared environmental or genetic risk factors;
(2) one condition causing the other; and
(3) the random co-occurrence of the two disorders.
The nonrandom co-occurrence of two conditions may be
attributable to methodological artifacts, including sampling bias, in which
samples are from clinical populations that are not representative of disease in
the general population, and assessment bias, in which the co occurrence of the
two conditions is an artifact of overlapping diagnostic criteria and lack of an
appropriate comparison group to control for factors that may confound the
Understanding the co
morbidity of migraine is important from both clinical and research perspectives
(Lipton and Silberstein, 1994). Co morbidity has implications for headache
diagnosis. Migraine has substantial symptomatic overlap with several of the
conditions co morbid with it. For example, both migraine and epilepsy can cause
transient alterations of consciousness as well as headache. This problem of
differential diagnosis is well recognized. Less well recognized is the problem
of concomitant diagnosis.
For conditions that are
co morbid with migraine, the presence of migraine should increase, not reduce,
the index of diagnostic suspicion. Co morbidity also has important implications
for treatment. Co morbid conditions may impose therapeutic limitations but may
also create therapeutic opportunities. For example, when migraine and
depression occur together, an antidepressant may successfully treat both.
Antiepileptic agents, such as divalproex sodium, gabapentin, and topiramate,
may prevent attacks of both migraine and epilepsy. Additionally, the study of co
morbidity may provide epidemiologic clues to the fundamental mechanisms of
Many studies of co
morbidity have methodological limitations. Studies of co morbidity require
reliable and valid definitions and systematic ascertainment of the conditions
being studied. Some studies conducted prior to the introduction of the
International Headache Society (IHS) diagnostic criteria for migraine (Headache
Classification Committee of the International Headache Society, 1988) used
idiosyncratic definitions of migraine (i.e., frequent headache, classical
migraine with neurologic prodromes).
often used thorough clinical evaluations, but selection or ascertainment bias
may have influenced measures of co morbidity. Epidemiologic studies often rely
on systematic screening of large populations. These studies generally use
validated methods to ascertain case status, which are less labor-intensive than
We believe that
definitive co morbidity studies must be conducted in population samples to
avoid the influence of selection or ascertainment bias. In this chapter, we
consider the conditions whose co morbidity with migraine is supported by
population studies: stroke, epilepsy, psychiatric disease, and Raynaud’s
syndrome. We also briefly review the evidence linking migraine and essential
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Aaron L Shechter
Richard B Lipton
Stephen D Silberstein
Editors: Silberstein, Stephen D.; Lipton, Richard B.;
Dalessio, Donald J.