Migraine associated with panic attacks

Migraine headache and panic disorder are two conditions that have a number of underlying physiological and psychological abnormalities in common. The temporal relationship between the occurrence of migraine headache and panic attacks could be different, however. According to our observations, some migraine subjects develop panic attacks with the typical symptoms (palpitation, dyspnea, anxiety/fear, shiver, sweating, polyuria) on the "peak" of their attacks. This variant of migraine without aura was conditionally defined as "panic migraine". Here we describe two patients suffering from migraine without aura in whom migraine was associated with the typical panic attack. It is suggested that a pronounced autonomic dysregulation along with marked psychological abnormalities could be responsible for the constellation of migraine and panic symptoms during one episode. Taking into account the previously obtained results, it is concluded that compared to "pure" migraine, "migraine associated with panic attacks" is characterized by a severe course, marked autonomic and emotional disturbances during pain-free intervals, seriously impaired quality of life, and requires a specific therapeutic approach.