comorbidities

If you have a dual diagnosis, that means that you have both a mental disorder and a substance use disorder (SUD), either with alcohol or drugs. A dual diagnosis is a type of comorbidity, which is when someone has two disorders at the same time. Another name for this is co-occurring disorders.

Mental and substance use disorders often occur together. Many people who develop SUDs are also diagnosed with mental disorders. And the reverse is true; many people with mental disorders will develop an SUD. Having both types of disorders is even more common in teenagers, people with serious mental illness, and people with certain mental disorders.

Although these problems often occur together, this does not mean that one caused the other, even if one appeared first. In fact, it can be hard to figure out which came first. Researchers think that there are three possible reasons as to why they often occur together:

• Common risk factors can contribute to both mental disorders and SUDs. These factors include:
  • Genetics.
  • Stress.
  • Trauma, especially in childhood. Veterans with post-traumatic stress disorder (PTSD) are also at risk for SUDs
• Mental disorders can contribute to drug use and SUDs. For example, people with mental disorders may use drugs or alcohol to try to feel better temporarily. This is known as self-medication. Also, mental disorders may change the brain to make it more likely that you will become addicted.
• Substance use and addiction can contribute to the development of a mental disorder. Substance use may change the brain in ways that make you more likely to develop a mental disorder.

If you have a dual diagnosis, it is usually better to treat both conditions at the same time rather than separately. You and your health care provider can work on a treatment plan that fits your needs.The plan should take into account your age, which substance(s) you are misusing, and which specific mental disorder(s) you have. The plan may include:

• Behavioral therapy, such as talk therapy (psychotherapy), long-term residential treatment (which combines housing and treatment services), and therapies to help you stay motivated to stick with your treatment plan.
• Medicines. There are effective medicines that treat opioid, alcohol, and nicotine addiction. There are also medicines that can lessen the symptoms of many mental disorders. Some medicines may treat more than one disorder.
• A referral to a support group. Support groups can give you emotional and social support. They are also a place where people can share tips about how to deal with day-to-day challenges.

NIH: National Institute on Drug Abuse

Migraines are a recurring type of headache. They cause moderate to severe pain that is throbbing or pulsing. The pain is often on one side of your head. You may also have other symptoms, such as nausea and weakness. You may be sensitive to light and sound.

Researchers believe that migraine has a genetic cause. There are also a number of factors that can trigger a migraine. These factors vary from person to person, and they include:

• Stress
• Anxiety
• Hormonal changes in women
• Bright or flashing lights
• Loud noises
• Strong smells
• Medicines
• Too much or not enough sleep
• Sudden changes in weather or environment
• Overexertion (too much physical activity)
• Tobacco
• Caffeine or caffeine withdrawal
• Skipped meals
• Medication overuse (taking medicine for migraines too often)

Some people have found that certain foods or ingredients can trigger headaches, especially when they are combined with other triggers. These foods and ingredients include:

• Alcohol
• Chocolate
• Aged cheeses
• Monosodium glutamate (MSG)
• Some fruits and nuts
• Fermented or pickled goods
• Yeast
• Cured or processed meats

About 12% of Americans get migraines. They can affect anyone, but you are more likely to have them if you:

• Are a woman. Women are three times more likely than men to get migraines.
• Have a family history of migraines. Most people with migraines have family members who have migraines.
• Have other medical conditions, such as depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.

There are four different phases of migraines. You may not always go through every phase each time you have a migraine.:

• Prodome. This phase starts up to 24 hours before you get the migraine. You have early signs and symptoms, such as food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination.
• Aura. If you have this phase, you might see flashing or bright lights or zig-zag lines. You may have muscle weakness or feel like you are being touched or grabbed. An aura can happen just before or during a migraine.
• Headache. A migraine usually starts gradually and then becomes more severe. It typically causes throbbing or pulsing pain, which is often on one side of your head. But sometimes you can have a migraine without a headache. Other migraine symptoms may include
• Increased sensitivity to light, noise, and odors
• Nausea and vomiting
• Worsened pain when you move, cough, or sneeze
• Postdrome (following the headache). You may feel exhausted, weak, and confused after a migraine. This can last up to a day.

Migraines are more common in the morning; people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.

To make a diagnosis, your health care provider will:

• Take your medical history
• Ask about your symptoms
• Do a physical and neurological exam

An important part of diagnosing migraines is to rule out other medical conditions which could be causing the symptoms. So you may also have blood tests, an MRI or CT scan, or other tests.

There is no cure for migraines. Treatment focuses on relieving symptoms and preventing additional attacks.

There are different types of medicines to relieve symptoms. They include triptan drugs, ergotamine drugs, and pain relievers. The sooner you take the medicine, the more effective it is.

There are also other things you can do to feel better:

• Resting with your eyes closed in a quiet, darkened room
• Placing a cool cloth or ice pack on your forehead
• Drinking fluids

There are some lifestyle changes you can make to prevent migraines:

• Stress management strategies, such as exercise, relaxation techniques, and biofeedback, may reduce the number and severity of migraines. Biofeedback uses electronic devices to teach you to control certain body functions, such as your heartbeat, blood pressure, and muscle tension.
• Make a log of what seems to trigger your migraines. You can learn what you need to avoid, such as certain foods and medicines. It also help you figure out what you should do, such as establishing a consistent sleep schedule and eating regular meals.
• Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle
• If you have obesity, losing weight may also be helpful

If you have frequent or severe migraines, you may need to take medicines to prevent further attacks. Talk with your health care provider about which drug would be right for you.

Certain natural treatments, such as riboflavin (vitamin B2) and coenzyme Q10, may help prevent migraines. If your magnesium level is low, you can try taking magnesium. There is also an herb, butterbur, which some people take to prevent migraines. But butterbur may not be safe for long-term use. Always check with your health care provider before taking any supplements.

NIH: National Institute of Neurological Disorders and Stroke