Pharmacological Approaches to Managing Migraine and Associated Comorbidities—Clinical Considerations for Monotherapy Versus Polytherapy


  • Stephen D. Silberstein MD,

  • David Dodick MD,

  • Fred Freitag DO,

  • Starr H. Pearlman PhD,

  • Steven R. Hahn MD,

  • Ann I. Scher PhD,

  • Richard B. Lipton MD

  • From the Thomas Jefferson University, Philadelphia, PA, USA (Dr. Silberstein); Mayo Clinic, Scottsdale, AZ, USA (Dr. Dodick); Diamond Headache Center, Chicago, IL, USA (Dr. Freitag); Savannah, GA, USA (Dr. Pearlman); Albert Einstein School of Medicine, Bronx, NY, USA (Drs. Hahn and Lipton); and Uniformed Services University, Bethesda, MD, USA (Dr. Scher).

Address all correspondence to Dr. Stephen D. Silberstein, Jefferson Headache Center, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107.


Comorbidity is defined as an illness that occurs more frequently in association with a specific disorder than would be found as a coincidental association in the general population. Conditions that are frequently comorbid with migraine include depression, anxiety, stroke, epilepsy, sleep disorders, and other pain disorders. In addition, many common illnesses occur concomitantly (at the same time) with migraine and influence the treatment choice. Migraine management, and especially migraine prevention, can be challenging when patients have comorbid or concomitant illnesses. The objectives of this initiative are to review the literature on managing patients who have migraine and common comorbidities, present additional clinical approaches for care of these difficult patients, and evaluate the areas in which research is needed to establish evidence-based guidelines for the management of migraine with associated comorbid conditions.