Do You Suffer From Migraine and Another Chronic Illness?
The comorbidities of migraine are many.
Posted March 6, 2021 | Reviewed by Ekua Hagan
About a year ago, I passed out for the first time, needing a few stitches on my chin, and while there were occasional times in the next few months that I fainted or nearly did, I never thought the episodes occurred frequently enough to mention them to a doctor. When I finally did, I was told I most likely had vasovagal syncope and needed to learn to get up more slowly.
But about four or five months ago, the fainting episodes came on more frequently—weekly, in fact, and I’d come close to really hurting myself. It was then I told my neurologist about them; she acted quickly to refer me to a cardiologist, who put me on a heart monitor for a month—which showed no problem.
I was developing life-altering, debilitating symptoms, likely some form of dysautonomia, maybe POT Syndrome, which is precipitated by a change in posture. It's an intolerance to change in position and occurs with a fast heart rate, leading to dizziness, light-headedness, extreme weakness and fatigue, and syncope (fainting).
Because my blood pressure had been running low, my cardiologist started me on midodrine (to raise the blood pressure, which would lower my heart rate), but I saw no real improvement in my symptoms, so the doctor doubled the dosage. Still no improvement. He told me he knew it was frustrating, but there really was no other treatment, except maybe a beta-blocker, which came with its own set of problems. As he left the room, he said, “We’ll reassess in a month.”
That conversation left me feeling helpless, alone, and not entirely believed, in terms of the severity of my symptoms and the impact this new condition was having on the quality of my life. A new assailant was joining forces, it seemed, with the old.
When I left the office, I realized I felt everything I have so often felt when dealing with chronic migraine:
These were all features I knew too well from living with migraine, but now I felt the assault of them from all new sources.
Where does this leave me? Whom do I turn to? And I have great medical care! What about the thousands who do not? I have great insurance. What about the thousands who do not? If I’m feeling this lost, how adrift must they be? The additional stress, depression, and anxiety of a possible second chronic illness that is possibly a comorbidity of migraine is overwhelming.
It seems that there are now no “good” days. If I don’t have a migraine, I now suffer the miserable symptoms of this new condition, and on some days, cope with both.
Herein lies the burden of migraine: There are so many comorbidities associated with the disease. I include only a few of the most common:
- Sleep disorders
- IBS (irritable bowel syndrome)
- Autonomic disorders (including POTS)
Comorbidity is defined as the presence of two or more chronic medical conditions that occur together at a greater than coincidental rate than what appears in the general population. It is common for people living with migraine to experience at least one comorbidity, according to Dr. Dawn Buse, Director of Behavioral Medicine at the Montefiore Headache Center: “Someone with chronic migraine has a 50% chance, maybe even up to an 80% chance, that they also experience anxiety,” Dr. Buse says, adding that these numbers make sense because people with migraine often feel anxiety about when their next migraine attack will occur and how it will affect their life (American Migraine Foundation). In addition to psychological comorbidities, neurologic/autonomic ones present themselves.
Nearly 30% of people with POTS ( Postural Orthostatic Tachycardia Syndrome) have migraine, according to Brent Goodman, M.D., of the Mayo Clinic in Scottsdale, Arizona, who conducted a retrospective study to investigate the link. Additionally, Dr. Goodman and his colleagues found that 46% of migraine patients experienced syncope—a loss of consciousness because of a drop in blood pressure—at least once and were more likely to experience recurrent syncopal episodes than people without migraine.
These and other findings suggest that migraine may be predisposed to having symptoms of orthostatic intolerance—problems that appear when standing up but disappear when sitting or lying down (“People with Migraine”).
I’ll continue to search for answers and hope that more research is done on the link between migraine and POTS, other forms of dysautonomia—the part of your nervous system that controls involuntary body functions like your heartbeat, breathing, and digestion, as well as the many other comorbidities so many migraineurs are forced to cope with.
When we say, “It’s So Much More than a Headache,” we really mean it. I’d love to hear your comments regarding the comorbidities of migraine you live with. Please feel free to share them on my blog.
“Comorbidities of Migraine.” American Migraine Foundation. August 2018. https://americanmigrainefoundation.org/resource-library/comorbidities-o… 5 March 2021.
“People With Migraine and Postural Tachycardia Syndrome”National Headache Foundation https://headaches.org/2015/05/04/migraineurs-frequently-experience-pots/). 2015. Accessed 4 March 2021.