Pharmacokinetic and pharmacodynamic considerations with psychiatric disorders and migraines
Abstract
Mr. B, age 44, presents to the clinic with increased anxiety and difficult-to-treat recurrent migraine headaches. His history is significant for migraines without aura, generalized anxiety disorder, major depressive disorder, and chronic insomnia. His current medications include aripiprazole 10 mg by mouth daily, propranolol 10 mg by mouth 3 times daily, mirtazapine 15 mg by mouth at bedtime, eletriptan 20 mg by mouth as needed for migraine, clonazepam 0.5 mg by mouth twice daily as needed for anxiety, and erenumab-aooe 70 mg subcutaneously monthly started several months ago. He has tried to identify and avoid migraine triggers with little success, and eletriptan has been minimally effective in ending migraine attacks. Since starting erenumab, he has experienced a modest reduction in frequency but still experiences multiple migraines monthly. He is looking for new options but is concerned about how his medications will “mix.”Migraine is a common and potentially disabling neurological disorder that affects an estimated 57 million people in the United States.1 Both migraine and psychiatric disorders have some genetic inheritance associated and also can be triggered by a variety of factors, including inflammation, environment, sleep disturbances, and stress. Individuals with migraines are 2 to 4 times more likely to have symptoms of depression compared with patients without. Anxiety disorders also commonly coincide with migraines.2 A 2021 meta-analysis of 6 studies looking at…
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