The need for inclusion of an anxiety screening tool during initial assessments of migraine patients has been highlighted by an Australian systematic review that confirmed a relationship between anxiety and migraine.

From an initial search of more than 2,000 citations, the review conducted by La Trobe University, Melbourne researchers, identified eight studies comparing anxiety outcomes in people 16 years and above, with and without migraine.

Validated anxiety screening tools used in the trials included the Goldberg Anxiety Disorder (GAD), Depression, Anxiety and Stress Score (DASS-21), Goldberg Anxiety Scale (GAS), Hamilton Anxiety Scale (HAS/HAMA), and self-reported anxious symptomology (RAS).

“In all the studies the results demonstrated a strong relationship in terms of Odds Ratios between anxiety and migraine compared to non-migraineurs. Both the Brazilian studies showed exceptionally high ORs (OR = 13 and 25…), with the other six studies showing ORs ranging from 1.77 to 4.5,” the review authors noted

“Clearly migraine and anxiety are comorbid, and the incidence of occurrence is almost four times higher compared to non-migraineurs.”

The study authors, writing in Frontiers in Neurology, said the findings suggested a joint predisposition or some related biological underpinnings in both migraine and anxiety.

It may also help explain why some anxiolytic medications work better than others for migraine mitigation.

They noted that more than a third of study participants who were diagnosed with migraine reported positive reduction in their migraine attacks as a result of receiving pharmacological treatment for their anxiety.

The researchers also highlighted the need for concurrent assessment of neurological symptoms of migraine and psychiatric symptoms associated with potential anxiety and depression.

“Currently there is little biological information regarding the onset of clinical anxiety with regard to the onset of the migrainous events or vice versa,” they wrote.

“Experimental studies on the chronological association of migraine and anxiety would be expected to lead to clinical trials regarding the effectiveness of known treatments for both migraine severity and debilitating anxiety.”

“Indeed, this will increase the likelihood of earlier detection and development of preventative strategies among people with migraine.”