Do you need to get a nexus letter for migraines secondary to PTSD, depression, anxiety, etc.? Dr. Finnerty is happy to review VA disability cases and write nexus letters for migraines secondary to already service connected PTSD, depression, anxiety and other mental health conditions (and mental health conditions due to already service connected migraines). Dr. Finnerty will review your medical records and review the scientific research related to the connection.
Some sample nexus letter statements and research Dr. Finnerty may use for migraine headaches secondary to PTSD:
Peterlin, et. al. (2011) noted that “of those with episodic migraine and PTSD, 69% reported symptoms related to PTSD before the onset of severe or frequent headache” [see Peterlin, et. al., Post-Traumatic Stress Disorder and Migraine: Epidemiology, Sex Differences, and Potential Mechanisms, Headache, 51(6): 860-868]. The authors note “it suggests that the presence of PTSD may be associated with an increased predisposition to the development of migraine.” “Hypotheses for the possible mechanisms contributing to the PTSD–migraine association include dysfunction of the autonomic system and the hypothalamic-pituitary-adrenal (HPA) axis. Supportive of the presence of sympathetic dysfunction, serotonin and norepinephrine levels have been demonstrated to be lower in both those with PTSD and those with migraine.” They note “migraine is a common, often disabling disorder associated with a significant personal and societal burden. The presence of post-traumatic stress disorder (PTSD) may increase this disability substantially.” Rao, et. al. (2015) [see The Impact of Post-Traumatic Stress Disorder on the Burden of Migraine: Results From the National Comorbidity Survey-Replication, Headache 55(10) 1323-1341] note that studies have linked PTSD with migraine and that the “association between posttraumatic stress disorder (PTSD) and migraine has become well-recognized.” There was a high comorbidity between migraine and PTSD and individuals with both “may be particularly prone to adverse financial, health, and interpersonal disease burdens.” The authors demonstrated “that the presence of PTSD in migraineurs may entail an even greater personal and societal burden than is found in individuals with migraine alone for several indicators of financial, health-related, and interpersonal disease burdens.” Peterlin, et. al. (2008) [see Post‐Traumatic Stress Disorder in Episodic and Chronic Migraine, Headache 48(4): 517-522]. found data that suggested “that PTSD may be a risk factor for headache chronification.” Individuals with PTSD and migraines were more likely to have more frequent and chronic headaches. Peterline, et. al (2011 [see Post-Traumatic Stress Disorder and Migraine: Epidemiology, Sex Differences, and Potential Mechanisms, Headache, 51(6): 860-868] note that “Migraine is a common, often disabling disorder associated with a significant personal and societal burden. The presence of post-traumatic stress disorder (PTSD) may increase this disability substantially.” They discuss neurobiological changes associated with PTSD that may be involved in the association with migraines, including “dysregulation of the autonomic system and HPA axis as well as structural alterations in the corpus callosum in response to PTSD.” They also point out that “the presence of PTSD in migraineurs is associated with greater headache-related disability than in migraineurs without PTSD.” Patients with PTSD have a significantly higher incidence of developing migraine [see Huang, et. al. (2019) Risk of developing migraine among patients with posttraumatic stress disorder: a nationwide longitudinal study. Taiwanese Journal of Psychiatry, 33:192-7]. Huang, et. al.’s 2019 study provided evidence “for the association between preceding PTSD and subsequent migraine. PTSD has been shown to worsen chronicity among patients with chronic pain…” Karsikaya, et. al. (2013) found that PTSD was found at a significantly higher rate in migraine patients compared to controls. “PTSD was observed commonly in migraine patients and more severe pain was reported by the subjects with PTSD…” [see Karsikaya, et. al. (2013) Post-traumatic stress disorder in migraine patients: Migraine, Trauma and Alexithymia; Archives of Neuropsychiatry, 50:263-268].
Some sample nexus letter statements and research Dr. Finnerty may use for migraine headaches secondary to other mental health conditions like depression and anxiety:
“Anxiety and mood disorders have been shown to be the most relevant psychiatric comorbidities associated with migraine, influencing its clinical course, treatment response, and clinical outcomes” [see Peres, et. al. (2017) Anxiety and depression symptoms and migraine: a symptom-based approach research; J Headache Pain, 18(1):37. Zhang, et. al. (2019) note “migraine comorbid with depression is common and is often encountered in clinical practice. The comorbidity may lead to more serious conditions with other symptoms and a longer duration of treatment and it may impose heavy economic and social burdens, directly or indirectly, on patients and their families. Numerous studies have been published on the association of migraine with depression. Numerous literature have showed that the comorbidity may have a common complicated pathogenic mechanism involving biopsychosocial characteristics, including abnormal brain development and shared genetic basis, as well as neurotransmitters, sex hormones and stress. In addition, some studies have identified the multiple, bidirectional relationship between migraine and depressive disorder” [see The exploration of mechanisms of comorbidity between migraine and depression; J Cell Mol Med 23(7):4505-4513].
Would you like to get a nexus letter for migraine headaches secondary to a mental health condition (or a mental health condition caused by migraines)?
Feel free to fill out the form for Dr. Finnerty to contact you here: Free Consultation – Nexus Letters from a Psychologist