Psychiatric and medical comorbidities in patients with migraine before and during the COVID-19 pandemic in Thailand: a retrospective comparative cohort study of two different clinical groups

AIM: Psychiatric and medical comorbidities are common in migraine and worsen pain burden and treatment outcomes. We examined the prevalence of comorbidities overall, before and during the COVID-19 pandemic, across migraine subtypes, and identified associated risk factors. METHODS: This retrospective comparative cohort study included patients diagnosed with migraine according to the International Classification of Headache Disorders at a tertiary headache center in Thailand. Clinical data were obtained from standardized case record forms and electronic medical records. Comorbidities were self-reported at the initial visit and verified by documented diagnoses. Group differences were analyzed using chi-square or independent t-tests. Multivariable logistic regression identified independent risk factors. RESULTS: Of the 572 patients, 29.9% had migraine with aura. Overall, 67.7% had at least one comorbidity, and 8.0% had psychiatric comorbidities. During the COVID-19 pandemic, overall and psychiatric comorbidities were more prevalent than in the pre-2020 period (79.4% vs. 66.2% and 17.4% vs. 6.9%, respectively). Chronic migraine was independently associated with comorbidities (adjusted OR 1.67, 95% CI 1.11-2.51), whereas the pre-COVID-19 period was associated with lower odds. CONCLUSIONS: Comorbidities are highly prevalent in migraine, particularly during the COVID-19 pandemic and among patients with chronic migraine. Integrated pain management and routine psychiatric screening may improve comprehensive care.